Journal of Electrocardiology
Volume 43, Issue 2 , Pages 161-166, March 2010

The utility of modified Butler-Leggett criteria for right ventricular hypertrophy in detection of clinically significant shunt ratio in ostium secundum–type atrial septal defect in adults

  • Adeel M. Siddiqui

      Affiliations

    • The Aga Khan University Hospital, Karachi, Pakistan
    • Corresponding Author InformationCorresponding author. The Aga Khan University Hospital, 46-A 2/2 3rd Sunset Street, Phase 2 Extension, Defence Housing Authority, Karachi, Pakistan.
    • ,
  • Zainab Samad, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
    • Duke Clinical Research Institute, Durham, NC, USA
    • ,
  • Nina Hakacova, MD

      Affiliations

    • Duke Clinical Research Institute, Durham, NC, USA
    • ,
  • James Kinsella

      Affiliations

    • University of Glasgow, Glasgow, United Kingdom
    • ,
  • Cary Ward, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
    • ,
  • Michael White, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
    • ,
  • Anna Lisa C. Crowley, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
    • ,
  • Galen S. Wagner, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
    • Duke Clinical Research Institute, Durham, NC, USA
    • ,
  • J. Kevin Harrison, MD

      Affiliations

    • Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA

Received 8 June 2009 published online 03 December 2009.

Abstract 

Background

This study was performed to test the hypothesis that there exists a correlation between the Butler-Leggett (BL) criterion for right ventricular hypertrophy on the electrocardiogram and the Qp/Qs shunt ratio in adults with ostium secundum atrial septal defects (ASDs).

Methods

Demographic, cardiac catheterization, ASD closure, and electrocardiographic data were acquired on 70 patients with secundum ASDs closed percutaneously. Simple linear regression and logistic regression models were created to test the hypothesis.

Results

The mean Qp/Qs ratio and BL criterion value were 1.61 ± 0.46 and 0.11 ± 0.41, respectively. The BL criterion values correlated with shunt ratios (r2 = 0.11 and P = .004). A BL criterion value greater than 0 mV predicted a significant shunt ratio (Qp/Qs ≥1.5) (odds ratio, 4.8; 95% confidence interval, 1.3, 18.1; P = <.0001) with a sensitivity of 0.68 and specificity of 0.65.

Conclusion

Our results indicate that there is limited utility of the BL criterion at detecting right ventricular volume overload, although a BL criterion value greater than 0 mV being used to identify patients with significant intracardiac shunts yielded a sensitivity of 0.68 and specificity of 0.65.

Keywords: Butler-Leggett criteria, Atrial septal defect, Right ventricular volume overload

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PII: S0022-0736(09)00538-X

doi:10.1016/j.jelectrocard.2009.10.001

Journal of Electrocardiology
Volume 43, Issue 2 , Pages 161-166, March 2010

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