{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T06:15:04Z","timestamp":1778220904763,"version":"3.51.4"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the diagnostic performance of acoustic\u2013electrocardiographic indices derived from a wearable phonocardiogram\u2013electrocardiogram (ECG) sensor for screening secundum atrial septal defect (ASD) in children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this cross-sectional study, 50 children (4\u201312 years) with secundum ASD and 50 age- and sex-matched healthy controls were enrolled. A wearable patch device recorded synchronized single-lead ECG and phonocardiogram, and S2 splitting time, S1\u2013S2, S1\u2013S2\/RR (%), EMAT and EMAT\/RR (%) were derived from artifact-free sinus beats at end-expiration. Group differences were assessed using independent-samples\n                      <jats:italic>t<\/jats:italic>\n                      -tests or\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      tests. Receiver operating characteristic analysis evaluated the ability of S2 splitting time and S1\u2013S2\/RR (%) to detect ASD, with optimal cut-offs defined by the Youden index. Multivariable logistic regression examined the independent association of these indices with ASD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Baseline demographic, anthropometric, and hemodynamic variables were well balanced between ASD and control groups. Compared with healthy controls, children with ASD had significantly prolonged S2 splitting time (39.65\u2009\u00b1\u20098.37 vs. 28.20\u2009\u00b1\u20098.91\u2005ms;\n                      <jats:italic>t<\/jats:italic>\n                      \u2009=\u20096.623,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) and an increased systolic fraction S1\u2013S2\/RR (%) (37.53\u2009\u00b1\u20092.39% vs. 34.47\u2009\u00b1\u20092.99%;\n                      <jats:italic>t<\/jats:italic>\n                      \u2009=\u20095.653,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), whereas S1\u2013S2 interval, EMAT, and EMAT\/RR (%) did not differ significantly between groups. ROC analysis showed that S2 splitting time had good discriminative ability for detecting ASD, with an area under the curve (AUC) of 0.831 [95% confidence interval (CI): 0.752\u20130.910]. A cut-off value of \u226531.75\u2005ms yielded a sensitivity of 0.90 and a specificity of 0.66. S1\u2013S2\/RR (%) demonstrated acceptable discrimination, with an AUC of 0.776 (95% CI 0.686\u20130.866) and an optimal cut-off of \u226535.25% (sensitivity 0.88, specificity 0.60). In multivariable logistic regression, both S2 splitting time [odds ratio (OR): 1.19 per 1-ms increase; 95% CI: 1.09\u20131.29;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001] and S1\u2013S2\/RR (%) (OR: 1.58 per 1% increase; 95% CI: 1.25\u20132.00;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001) remained independently associated with ASD.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Wearable acoustic\u2013electrocardiographic monitoring enables quantitative assessment of S2 splitting and systolic time fractions in children. Prolonged S2 splitting time and increased S1\u2013S2\/RR (%) are characteristic of secundum ASD and show good diagnostic performance, supporting these simple indices from a patch-type phonocardiogram\u2013ECG sensor as a practical non-invasive tool for pediatric ASD screening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1774994","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T05:52:20Z","timestamp":1778219540000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic performance of wearable acoustic\u2013electrocardiographic indices for screening secundum atrial septal defect in children"],"prefix":"10.3389","volume":"14","author":[{"given":"Jinyong","family":"Pan","sequence":"first","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital of Shihezi University","place":["Shihezi, Xinjiang Uygur Autonomous Region, 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First Affiliated Hospital of Shihezi University","place":["Shihezi, Xinjiang Uygur Autonomous Region, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muqing","family":"Niu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital of Shihezi University","place":["Shihezi, Xinjiang Uygur Autonomous Region, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital of Shihezi University","place":["Shihezi, Xinjiang Uygur Autonomous Region, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heyun","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The First Affiliated Hospital of Shihezi University","place":["Shihezi, Xinjiang Uygur Autonomous Region, 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