{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T16:48:00Z","timestamp":1755794880992,"version":"3.44.0"},"reference-count":21,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"unspecified","delay-in-days":117,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,4,1]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Cardiac magnetic resonance (CMR) is the gold standard for assessing right ventricular (RV) function in repaired tetralogy of Fallot (rTOF), but it is expensive and not always available. ECG is a cost-effective, accessible alternative. This study evaluated ECG parameters, specifically QRS duration (QRSd) and QRS fragmentation (QRSf), to predict RV volumes and function, and developed a new score to guide CMR timing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively analysed 147 patients with rTOF with pulmonary regurgitation. ECG, echocardiographic and CMR data were collected. Receiver operating characteristic curves identified optimal cut-offs for predicting RV dysfunction and dilation. Logistic regression was used to determine predictors of RV dysfunction and dilation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>QRSd showed moderate positive correlations with RV end-diastolic (EDVi) and end-systolic (ESVi) volume indices and negative correlations with RV ejection fraction (EF) and global radial strain. QRSf was associated with larger RVESVi and lower RVEF. We propose a simple risk score of age\u202f\u226420 years, QRSd\u2265160 ms, QRSf and transannular patch repair. A score\u202f&gt;2.5 out of 5.5 predicted RVEDVi\u202f\u2265150\u2009mL\/m<jats:sup>2<\/jats:sup> with 76.5% sensitivity and 63.6% specificity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study highlights the value of ECG, particularly QRSd\u2265160 ms and QRSf, in predicting RV dilation in rTOF. The proposed score, based on clinical data and ECG parameters, offers a practical tool for guiding the timing of CMR.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003255","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T01:50:16Z","timestamp":1745891416000},"page":"e003255","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Simple ECG-based score and clinical parameters to predict right ventricular dilation in patients with repaired tetralogy of fallot"],"prefix":"10.1136","volume":"12","author":[{"given":"Pornphairin","family":"Satawichairut","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0261-7007","authenticated-orcid":false,"given":"Paweena","family":"Chungsomprasong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Watcharachai","family":"Kangvanskol","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7124-2064","authenticated-orcid":false,"given":"Chodchanok","family":"Vijarnsorn","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karnkawin","family":"Patharateeranart","sequence":"additional","affiliation":[{"name":"Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prakul","family":"Chanthong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Supaluck","family":"Kanjanauthai","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thita","family":"Pacharapakornpong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ploy","family":"Thammasate","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kritvikrom","family":"Durongpisitkul","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jarupim","family":"Soongswang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,4,28]]},"reference":[{"key":"2025081612163400000_12.1.e003255.1","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1016\/j.hlc.2020.04.017","article-title":"Assessment of Disease Progression in Patients With Repaired Tetralogy of Fallot Using Cardiac Magnetic Resonance Imaging: A Systematic Review","volume":"29","author":"Mohamed","year":"2020","journal-title":"Heart Lung Circ"},{"key":"2025081612163400000_12.1.e003255.2","doi-asserted-by":"crossref","DOI":"10.1186\/s12947-018-0146-7","article-title":"Long-term follow-up in adults after tetralogy of Fallot repair","volume":"16","author":"D\u0142u\u017cniewska","year":"2018","journal-title":"Cardiovasc Ultrasound"},{"key":"2025081612163400000_12.1.e003255.3","doi-asserted-by":"publisher","DOI":"10.1177\/0284185113491565"},{"key":"2025081612163400000_12.1.e003255.4","doi-asserted-by":"crossref","unstructured":"van der Ven JPG , van den Bosch E , Bogers A , et al . 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Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009;39\u201347. doi:10.1053\/j.pcsu.2009.01.021","DOI":"10.1053\/j.pcsu.2009.01.021"},{"key":"2025081612163400000_12.1.e003255.7","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1053\/j.semtcvs.2018.10.015","article-title":"Tetralogy of Fallot in the Current Era","volume":"31","author":"Mouws","year":"2019","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"2025081612163400000_12.1.e003255.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.06.008"},{"key":"2025081612163400000_12.1.e003255.9","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezs221"},{"key":"2025081612163400000_12.1.e003255.10","doi-asserted-by":"crossref","unstructured":"Redington AN . Physiopathology of right ventricular failure. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006;3\u201310. doi:10.1053\/j.pcsu.2006.02.005","DOI":"10.1053\/j.pcsu.2006.02.005"},{"key":"2025081612163400000_12.1.e003255.11","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi091"},{"key":"2025081612163400000_12.1.e003255.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.10.001"},{"key":"2025081612163400000_12.1.e003255.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0828-282X(10)70355-X"},{"key":"2025081612163400000_12.1.e003255.14","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq249"},{"key":"2025081612163400000_12.1.e003255.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2011.07.070"},{"key":"2025081612163400000_12.1.e003255.16","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.2.231"},{"key":"2025081612163400000_12.1.e003255.17","article-title":"QRS fragmentation versus QRS prolongation in predicting right ventricular enlargement and dysfunction in children and adults with repaired Tetralogy of Fallot","volume":"13","author":"Gaydos","year":"2023","journal-title":"Int J Cardiol Congenit Heart Dis"},{"key":"2025081612163400000_12.1.e003255.18","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1016\/j.rec.2014.04.019","article-title":"Value of the Electrocardiogram as a Predictor of Right Ventricular Dysfunction in Patients With Chronic Right Ventricular Volume Overload","volume":"68","author":"Alonso","year":"2015","journal-title":"Revista Espa\u00f1ola de Cardiolog\u00eda (English Edition)"},{"key":"2025081612163400000_12.1.e003255.19","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.118.010274","article-title":"Role of QRS Fragmentation for Risk Stratification in Adults With Tetralogy of Fallot","volume":"7","author":"Egbe","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2025081612163400000_12.1.e003255.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2012.04.004"},{"key":"2025081612163400000_12.1.e003255.21","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1093\/eurheartj\/ehaa554","article-title":"2020 ESC Guidelines for the management of adult congenital heart disease: The Task Force for the management of adult congenital heart disease of the European Society of Cardiology (ESC). 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