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Войти в исследования Frontiers in pediatrics · 2026
Diagnostic performance of wearable acoustic-electrocardiographic indices for screening secundum atrial septal defect in children.
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Pan Jinyong, Zhang Fengling, Guo Yan, Li Hu, Chen Yonglin, Niu Muqing, Zhang Yan, Xiong Heyun
Аннотация
OBJECTIVE: To evaluate the diagnostic performance of acoustic-electrocardiographic indices derived from a wearable phonocardiogram-electrocardiogram (ECG) sensor for screening secundum atrial septal defect (ASD) in children.
METHODS: In this cross-sectional study, 50 children (4-12 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-S2, S1-S2/RR (%), EMAT and EMAT/RR (%) were derived from artifact-free sinus beats at end-expiration. Group differences were assessed using independent-samples t-tests or χ 2 tests. Receiver operating characteristic analysis evaluated the ability of S2 splitting time and S1-S2/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.
RESULTS: 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 ± 8.37 vs. 28.20 ± 8.91 ms; t = 6.623, P < 0.001) and an increased systolic fraction S1-S2/RR (%) (37.53 ± 2.39% vs. 34.47 ± 2.99%; t = 5.653, P < 0.001), whereas S1-S2 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): 0.752-0.910]. A cut-off value of ≥31.75 ms yielded a sensitivity of 0.90 and a specificity of 0.66. S1-S2/RR (%) demonstrated acceptable discrimination, with an AUC of 0.776 (95% CI 0.686-0.866) and an optimal cut-off of ≥35.25% (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: 1.09-1.29; P < 0.001] and S1-S2/RR (%) (OR: 1.58 per 1% increase; 95% CI: 1.25-2.00; P < 0.001) remained independently associated with ASD.
CONCLUSIONS: Wearable acoustic-electrocardiographic monitoring enables quantitative assessment of S2 splitting and systolic time fractions in children. Prolonged S2 splitting time and increased S1-S2/RR (%) are characteristic of secundum ASD and show good diagnostic performance, supporting these simple indices from a patch-type phonocardiogram-ECG sensor as a practical non-invasive tool for pediatric ASD screening.
METHODS: In this cross-sectional study, 50 children (4-12 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-S2, S1-S2/RR (%), EMAT and EMAT/RR (%) were derived from artifact-free sinus beats at end-expiration. Group differences were assessed using independent-samples t-tests or χ 2 tests. Receiver operating characteristic analysis evaluated the ability of S2 splitting time and S1-S2/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.
RESULTS: 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 ± 8.37 vs. 28.20 ± 8.91 ms; t = 6.623, P < 0.001) and an increased systolic fraction S1-S2/RR (%) (37.53 ± 2.39% vs. 34.47 ± 2.99%; t = 5.653, P < 0.001), whereas S1-S2 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): 0.752-0.910]. A cut-off value of ≥31.75 ms yielded a sensitivity of 0.90 and a specificity of 0.66. S1-S2/RR (%) demonstrated acceptable discrimination, with an AUC of 0.776 (95% CI 0.686-0.866) and an optimal cut-off of ≥35.25% (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: 1.09-1.29; P < 0.001] and S1-S2/RR (%) (OR: 1.58 per 1% increase; 95% CI: 1.25-2.00; P < 0.001) remained independently associated with ASD.
CONCLUSIONS: Wearable acoustic-electrocardiographic monitoring enables quantitative assessment of S2 splitting and systolic time fractions in children. Prolonged S2 splitting time and increased S1-S2/RR (%) are characteristic of secundum ASD and show good diagnostic performance, supporting these simple indices from a patch-type phonocardiogram-ECG sensor as a practical non-invasive tool for pediatric ASD screening.