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

BackgroundThis 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).MethodsDemographic, 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.ResultsThe 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.ConclusionOur 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.