{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T11:06:20Z","timestamp":1780484780407,"version":"3.54.1"},"reference-count":19,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Atrial septal defect (ASD) is common in adults and may cause chronic right ventricular (RV) volume overload and remodeling. Electrocardiography (ECG) may serve as a screening adjunct to echocardiography. Objectives: To evaluate the association of the terminal D1S + D3R ECG pattern, defined as a terminal S wave in lead I plus a terminal R wave in lead III, with structural and hemodynamic right heart involvement in adult secundum ASD. Methods: A total of 161 adult patients with secundum ASD were retrospectively analyzed. Right heart involvement was assessed using pulmonary-to-systemic flow ratio (Qp\/Qs) \u2265 1.5 and a right ventricular\/left ventricular (RV\/LV) ratio &gt; 1. ECG parameters, including right bundle branch block (RBBB), right axis deviation, V1\u2013V2 R-wave positivity, and terminal D1S + D3R, were evaluated by two blinded cardiologists, with final classifications determined by consensus. Multivariable Firth penalized logistic regression, correlation analyses, and receiver operating characteristic (ROC) analyses were performed. Results: In the multivariable Firth penalized logistic regression model, pulmonary artery pressure (PAP) and ASD diameter were independently associated with Qp\/Qs \u2265 1.5, whereas the terminal D1S + D3R pattern was not. The terminal D1S + D3R pattern was independently associated with RV dilatation after adjustment for age, sex, PAP, and ASD diameter (odds ratio [OR]: 9.90, 95% confidence interval [CI]: 2.82\u201338.20, p &lt; 0.001) and showed good discriminatory performance for RV dilatation (area under the curve [AUC]: 0.881, 95% CI: 0.831\u20130.932). Conclusions: In adults with secundum ASD, a positive terminal D1S + D3R ECG pattern is independently associated with RV dilatation and may serve as a practical adjunctive screening marker. However, it should not replace echocardiographic assessment.<\/jats:p>","DOI":"10.3390\/jcdd13060245","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T09:33:14Z","timestamp":1780479194000},"page":"245","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Value of the Terminal D1S + D3R Pattern for Detecting Right Ventricular Dilatation in Patients with Atrial Septal Defect"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8453-205X","authenticated-orcid":false,"given":"Rauf","family":"Avc\u0131","sequence":"first","affiliation":[{"name":"Turkish Ministry of Health Antalya Training and Research Hospital, 07100 Antalya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatih Han","family":"Kumta\u015f","sequence":"additional","affiliation":[{"name":"Cardiology Department, Elbistan State Hospital, 46300 Kahramanmara\u015f, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1016\/S0735-1097(02)01886-7","article-title":"The incidence of congenital heart disease","volume":"39","author":"Hoffman","year":"2002","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1016\/S0140-6736(13)62145-5","article-title":"Atrial septal defects","volume":"383","author":"Geva","year":"2014","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1016\/j.jacc.2021.08.082","article-title":"Transcatheter closure of atrial and ventricular septal defects: JACC focus seminar","volume":"79","author":"Turner","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2778","DOI":"10.1016\/j.jacc.2018.08.2201","article-title":"Echocardiographic screening for pulmonary hypertension in congenital heart disease: JACC review topic of the week","volume":"72","author":"Dimopoulos","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","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","volume":"42","author":"Baumgartner","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_6","first-page":"233","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"16","author":"Lang","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1016\/j.jacc.2018.08.1028","article-title":"2018 AHA\/ACC guideline for the management of adults with congenital heart disease: Executive summary","volume":"73","author":"Stout","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1136\/heartjnl-2014-305690","article-title":"Survival prospects of treatment na\u00efve patients with Eisenmenger: A systematic review of the literature and report of own experience","volume":"100","author":"Diller","year":"2014","journal-title":"Heart"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1093\/eurheartj\/eht437","article-title":"Pulmonary hypertension related to congenital heart disease: A call for action","volume":"35","author":"Dimopoulos","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2796","DOI":"10.1161\/CIRCULATIONAHA.105.594218","article-title":"Abnormal ventilatory response to exercise in adults with congenital heart disease relates to cyanosis and predicts survival","volume":"113","author":"Dimopoulos","year":"2006","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1093\/eurheartj\/ehr461","article-title":"Reference values for exercise limitations among adults with congenital heart disease. Relation to activities of daily life\u2014Single centre experience and review of published data","volume":"33","author":"Kempny","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1093\/eurheartj\/ehl116","article-title":"Presentation, survival prospects, and predictors of death in Eisenmenger syndrome: A combined retrospective and case\u2013control study","volume":"27","author":"Diller","year":"2006","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1179546819869948","DOI":"10.1177\/1179546819869948","article-title":"The accuracy of combined electrocardiogram criteria to diagnose right atrial enlargement in adults with uncorrected secundum atrial septal defect","volume":"13","author":"Rio","year":"2019","journal-title":"Clin. Med. Insights Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"ehz872.067","DOI":"10.1093\/ehjci\/ehz872.067","article-title":"P193 the value of 12-lead electrocardiogram in secundum atrial defect with pulmonary hypertension","volume":"41","author":"Santoso","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.ijcard.2007.06.005","article-title":"Predictive values of the electrocardiogram in diagnosing pulmonary hypertension","volume":"127","author":"Hijal","year":"2008","journal-title":"Int. J. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1007\/s00246-023-03324-5","article-title":"Electrocardiographic characteristics in 438 neonates with atrial septal defects","volume":"45","author":"Dehn","year":"2024","journal-title":"Pediatr. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1111\/ped.12569","article-title":"Relationship between electrocardiographic signs and shunt volume in atrial septal defect","volume":"57","author":"Somura","year":"2015","journal-title":"Pediatr. Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"152","DOI":"10.4103\/0974-2069.205139","article-title":"Correlation of electrocardiogram parameters and hemodynamic outcomes in patients with isolated secundum atrial septal defects","volume":"10","author":"Refaei","year":"2017","journal-title":"Ann. Pediatr. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1080\/00015385.2024.2396760","article-title":"A new electrocardiographic parameter terminal D1S+D3R predicts right ventricular dilatation in acute pulmonary embolism","volume":"79","author":"Turan","year":"2024","journal-title":"Acta Cardiol."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/6\/245\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T10:21:33Z","timestamp":1780482093000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/6\/245"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":19,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcdd13060245"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13060245","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]}}}