Search Results (335)

Patchouli alcohol, a natural tricyclic sesquiterpene isolated from Pogostemon cablin, exhibits promising antimicrobial properties, yet its activity against Streptococcus mutans (S. mutans), a major cariogenic bacterium associated with dental caries, has not been characterized. This study determined the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of patchouli alcohol against S. mutans to be 40 and 80 μg/mL, respectively. A series of phenotypic assays showed that patchouli alcohol delayed bacterial growth and culture acidification, reduced extracellular polysaccharide production, and decreased the biomass and metabolic activity of established S. mutans biofilms. Scanning electron microscopy showed treatment-associated changes in the surface morphology of S. mutans, with more evident deformation at MIC and 2MIC. Real-time quantitative PCR showed that sub-MIC treatment (20 μg/mL) significantly downregulated virulence genes associated with adhesion (gbpB and spaP), EPS synthesis (gtfB, gtfC, gtfD, and ftf), acid production (ldh, atpF, and atpD), and the two-component regulatory and quorum sensing systems (vicK, vicR, and luxS). These results suggest that patchouli alcohol may serve as a potential natural anti-cariogenic candidate targeting S. mutans-associated virulence traits under in vitro conditions. Full article

Background/Objectives: Obstructive sleep apnea (OSA) is traditionally diagnosed via polysomnography (PSG) using the apnea–hypopnea index (AHI). However, AHI alone may inadequately reflect the clinical heterogeneity, symptom burden, and cardiometabolic consequences of the disease. The Baveno classification incorporates symptom severity and comorbidity burden into a multidimensional framework. We aimed to evaluate the agreement between PSG-staging and the Baveno classification, to investigate the impact of reclassification on positive airway pressure (PAP) treatment recommendations. Methods: This retrospective study included 395 adults with OSA diagnosed via PSG between January 2016 and June 2024. Patients were categorized according to PSG severity (mild, moderate, and severe) and Baveno phenotypes (A, B, C, D). PAP therapy indication was defined as AHI ≥ 15 events/hour in the PSG-based classification and as Baveno groups B-D in the multidimensional approach. Agreement between the systems was assessed using Cohen’s kappa coefficient. Results: PAP therapy was indicated in 252 patients (63.8%) via PSG and in 268 patients (67.8%) via the Baveno classification. Overall agreement between the systems was 63.5%, (κ = 0.191) and increased with disease severity, reaching 87.1% with severe OSA. Overall, 144 patients (36.5%) were reclassified, including 80 patients newly identified as candidates for PAP therapy and 64 patients reclassified as not requiring PAP therapy according to the Baveno framework. BMI showed only a weak correlation with AHI overall and no significant association in women. Conclusions: Combined use of PSG and the Baveno approach provides more individualized PAP treatment decisions, particularly among clinically heterogeneous patients and those within intermediate severity categories. Full article

Phosphatidate phosphatase (PAP) governs a critical branchpoint in glycerolipid synthesis by catalyzing the Mg²⁺-dependent dephosphorylation of phosphatidate (PA) to diacylglycerol (DAG), thereby controlling the partitioning of lipid flux between membrane phospholipid synthesis and triacylglycerol (TAG) storage. While the structure, regulation, and function of ScPah1 have been extensively characterized in the non-oleaginous yeast Saccharomyces cerevisiae, far less is known about its ortholog in the oleaginous yeast Yarrowia lipolytica. This review provides a comparative analysis of Pah1 between the two yeasts, encompassing domain architecture, phosphorylation-dependent regulation, enzymatic characterization, and genetic and multi-omics studies. ScPah1 and YlPah1 share a conserved HAD-like catalytic core but diverge substantially in their regulatory domains: YlPah1 features compressed intrinsically disordered regions, an attenuated regulation of phosphorylation (RP) domain, and a massively expanded acidic tail. Unlike ScPah1, which is hyperphosphorylated and cytosolically sequestered during growth, YlPah1 maintains membrane association and increasing protein levels throughout growth. Deletion of PAH1 in Y. lipolytica produces a moderate reduction in TAG levels with evidence of metabolic redundancy, contrasting with the near-complete TAG loss observed in S. cerevisiae. Total PAP activity in Y. lipolytica peaks during exponential growth and does not correlate temporally with TAG accumulation, a dissociation attributable to the contributions of non-Pah1 PAP enzymes. Whether the Nem1–Spo7 homologs in Y. lipolytica form a functional phosphatase complex and the individual contributions of all PAP-encoding genes to lipid homeostasis remain important unresolved questions. Full article

Heavy metal pollution has become a major environmental challenge limiting agricultural productivity worldwide. Copper (Cu), although an essential micronutrient, becomes phytotoxic at elevated concentrations, primarily by inducing oxidative stress. Among the most widespread metabolic adjustments triggered by abiotic stress is the accumulation of proline, which is a compatible osmolyte that stabilizes proteins and membranes and helps maintain cellular redox homeostasis. This paper demonstrates that the heterologous expression of TsPAP1, a triticale gene encoding a prolyl aminopeptidase, enhances proline accumulation and confers increased Cu tolerance in Arabidopsis thaliana. Under Cu stress, transgenic lines maintained superior physiological performance relative to the wild type (WT), as evidenced by the reduced biomass loss and lower accumulation of malondialdehyde and reactive oxygen species. Cu exposure activated antioxidant defenses; however, the induction of catalase (CAT), class III peroxidases (POD), ascorbate peroxidase (APX), and glutathione reductase (GR) activities was more pronounced in transgenic lines. Transcriptomic analysis revealed a higher expression of genes encoding antioxidant isoforms localized to chloroplasts (sAPX, CSD2), the cytosol (APX1), peroxisomes (CAT1), and the apoplast (Prx02, Prx51), indicating targeted reinforcement of the multi-compartmental redox defense system. Together, these findings identify TsPAP1 as a potential regulator of proline-dependent redox homeostasis that contributes to enhanced Cu tolerance through the coordinated activation of antioxidant networks. The results further suggest that PAP-dependent peptide turnover contributes to proline-mediated stress adaptation, linking peptide metabolism with antioxidant regulation and highlighting TsPAP1 as a promising target for engineering heavy metal-resilient crops. Full article

Background: Dyspnea is common in pregnancy and difficult to assess in the emergency department (ED), as it may reflect physiological adaptation or cardiopulmonary pathology. We evaluated whether novel BNP-derived uric acid composite indices aid the assessment of dyspnea in late pregnancy; to our knowledge, this is the first study of such indices in this setting. Methods: In this prospective observational study, third-trimester pregnant women (≥27 weeks) presenting to the ED with dyspnea were compared with age-matched asymptomatic pregnant controls. All underwent laboratory testing (including BNP, D-dimer, and uric acid) and standardised transthoracic echocardiography. Three composite indices were calculated (BNP/Albumin, BNP/Uric acid, and BNP × Uric acid), and diagnostic performance was assessed by receiver operating characteristic (ROC) analysis. Results: A total of 215 women were included (100 dyspnea, 115 controls). The dyspnea group had significantly higher D-dimer, BNP, uric acid, and all three composite indices (all p < 0.001), together with higher systolic pulmonary artery pressure (sPAP), right atrial and ventricular diameters, and lateral E/e′. Uric acid (AUC 0.998), the BNP × Uric acid product (AUC 0.846), and sPAP (AUC 0.836) showed the strongest discrimination; the BNP × Uric acid product outperformed BNP, D-dimer, and BNP/Albumin individually but did not surpass uric acid alone. Conclusions: Dyspneic third-trimester women show subtle but significant cardiopulmonary changes despite values that largely remain within normal ranges. These changes distinguished symptomatic from asymptomatic pregnancy but remained largely within normal ranges and do not by themselves identify acute cardiopulmonary disease; uric acid alone was the strongest discriminator, and the composite indices are proposed only as hypothesis-generating tools requiring external validation, ideally against dyspnoeic pregnant women with confirmed pathology. Full article

Objective: Pulmonary arterial hypertension (PAH) is a progressive disease leading to right ventricular (RV) hypertrophy and failure. This study aims to evaluate the prognostic value of combining the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/sPAP) ratio with right ventricular myocardial work (RVMW) parameters in patients with PAH, to improve early risk stratification. Methods: A total of 43 PAH patients diagnosed via right heart catheterization were enrolled. Echocardiography-derived TAPSE/sPAP ratio and RVMW parameters, including right ventricular global work efficiency (RVGWE), global work index (RVGWI), global constructive work (RVGCW), and global wasted work (RVGWW), were measured. Clinical worsening events were recorded during a median 515-day follow-up. Statistical analyses included correlation tests, Firth penalized logistic regression, receiver operating characteristic (ROC) curves, and Kaplan–Meier survival analysis. Results: The TAPSE/sPAP ratio correlated negatively with RVGCW (r = −0.346, p = 0.023) and RVGWW (r = −0.417, p = 0.005), but not with RVGWE or RVGWI. Clinical worsening events occurred in 25.6% of patients, with significantly lower TAPSE/sPAP ratio (0.16 vs. 0.24 mm/mmHg), RVGWE (72.0% vs. 88.5%), and RVGWI (431.0 vs. 641.0 mmHg%) in the Event group (all p < 0.05). Multivariate Firth penalized logistic regression was used for combining TAPSE/sPAP ratio with RVGWE. ROC analysis demonstrated that the combination of TAPSE/sPAP and RVGWE yielded superior predictive power (AUC = 0.949, p < 0.001) compared to individual parameters. Conclusion: Non-invasive assessment of TAPSE/sPAP ratio and RVGWE provides significant prognostic value in PAH. Their combination enhances early risk prediction, offering a practical tool for clinical management. Full article

Background/Objectives: Tricuspid valve surgery carries a high risk of postoperative acute kidney injury (AKI) due to pre-existing right ventricular dysfunction and congestive end-organ remodeling. We aimed to evaluate the incidence and predictors of postoperative AKI, with particular focus on the prognostic value of the TAPSE/sPAP index. Methods: This retrospective, single-center study evaluated adult patients who underwent tricuspid valve surgery (isolated/concomitant) between 2010 and 2025. The primary outcome was postoperative AKI of any stage, defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Predictors were identified using a pre-specified multivariable logistic regression model including baseline estimated glomerular filtration rate (eGFR), cardiopulmonary bypass time, and EuroSCORE II; TAPSE/sPAP associations with severe renal outcomes were assessed univariably and presented as exploratory. Results: Of 80 patients, postoperative AKI occurred in 32 (40.0%), with 16 (20.0%) requiring renal replacement therapy. The pre-specified multivariable model discriminated any-stage AKI (AUC 0.86, 95% CI 0.77–0.94). Lower baseline eGFR (adjusted OR 1.82 per 10 mL/min/1.73 m² decrease, p < 0.001) and higher EuroSCORE II (adjusted OR 1.53 per point, p = 0.03) were independent predictors. The TAPSE/sPAP index was not associated with any-stage AKI (p = 0.42), but lower values predicted advanced renal outcomes, including KDIGO stage ≥ 2 AKI (OR 2.11, p = 0.03) and the requirement for renal replacement therapy (OR 2.71, p = 0.01). Outcomes did not differ between isolated (n =14) and combined procedures (n = 66; AKI 35.7% vs. 40.9%, p = 0.77). Conclusions: Lower preoperative eGFR and higher EuroSCORE II independently predict any-stage postoperative AKI. In univariable analysis, the TAPSE/sPAP index identified the subgroup with severe renal outcomes; this exploratory finding requires prospective validation. Whether perioperative renal protection depends on addressing right-sided filling pressures rather than augmenting forward flow alone requires prospective testing. Full article

Background: Pulmonary Alveolar Proteinosis (PAP) is a rare interstitial lung disease characterized by intra-alveolar accumulation of lipoproteinaceous material. Although its radiologic features are well documented, the disease’s impact on cardiovascular mechanics—specifically right ventricular (RV) adaptation—remains underexplored. This study aims to explore the correlation between radiologic severity of parenchymal involvement, quantified by high-resolution computed tomography (HRCT) scores, and right heart hemodynamics, with a focus on RV-pulmonary artery (RV-PA) coupling and interventricular interaction. Methods: This retrospective observational study analyzed 13 adult patients with confirmed PAP and 70 age- and sex-matched healthy controls. All participants underwent concurrent thoracic HRCT and transthoracic echocardiography. Structural lung damage and “crazy-paving” patterns were quantified using a total lobar HRCT score ranging from 0 to 30. Echocardiographic evaluation assessed right heart hemodynamics, using the tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure ratio (TAPSE/sPAP) as an index of RV-PA coupling and the RV/LV ratio. Given the small sample size, p-values for correlations were adjusted for multiple comparisons using the Bonferroni method, and findings should be regarded as exploratory. Results: Left ventricular parameters were preserved across both groups. However, PAP patients had significantly impaired right heart indices compared with controls, including a larger RV basal diameter (37.2 ± 2.3 vs. 32.6 ± 1.6 mm, p < 0.001), higher sPAP (38.5 ± 3.5 vs. 23.6 ± 2.9 mmHg, p < 0.001), and a higher RV/LV ratio (0.98 ± 0.19 vs. 0.60 ± 0.06, p < 0.001). Furthermore, the RV-PA coupling marker, TAPSE/sPAP, was markedly reduced in the PAP cohort (0.43 ± 0.07 vs. 0.88 ± 0.13 mm/mmHg, p < 0.001). After Bonferroni correction, elevated HRCT scores remained strongly associated with a higher RV/LV ratio (r = 0.89, p < 0.001) and a lower TAPSE/sPAP ratio (r = −0.90, p < 0.001). Subgroup analysis indicated that patients with severe radiological scores had more pronounced RV enlargement and lower RV-PA coupling reserves. Conclusions: In this exploratory analysis, radiographic severity of alveolar lipoproteinaceous accumulation in PAP was strongly associated with isolated right ventricular dysfunction and impaired RV-PA coupling, despite preserved left heart function. These hypothesis-generating findings suggest that echocardiographic assessment of TAPSE/sPAP and RV/LV ratios may be useful for the clinical follow-up of PAP patients; however, causality cannot be inferred from this small, retrospective, single-center cohort, and larger prospective studies are warranted. Full article

Background: Although chronic venous insufficiency is often treated as a localized problem, it is a systemic condition that can negatively affect cardiac hemodynamics. This study investigates the associated effects of eliminating the pathologic venous reservoir on right ventricular (RV) functions, systolic pulmonary artery pressure (sPAP), and inferior vena cava (IVC) diameter in patients undergoing endovenous radiofrequency ablation (RFA) for severe great saphenous vein (GSV) insufficiency. Methods: This retrospective observational study included 154 patients who presented between September 2023 and May 2025 with GSV insufficiency (CEAP C3-C4b) and underwent endovenous RFA. Patients with major cardiopulmonary diseases were strictly excluded. Preoperative and 6-month postoperative transthoracic echocardiography records were analyzed to evaluate RV diastolic diameter, tricuspid annular plane systolic excursion (TAPSE), sPAP, the TAPSE/sPAP ratio, and IVC diameter. Results: At 6 months post-RFA, compared to preoperative values, a significant decrease was detected in the mean sPAP (14.7 ± 2.5 vs. 11.8 ± 1.8 mmHg, p < 0.001) and IVC diameter (2.1 ± 0.2 vs. 1.9 ± 0.2 cm, p < 0.001). Furthermore, significant improvements were observed in TAPSE (20.0 ± 2.0 vs. 21.5 ± 1.8 mm, p < 0.001) and the TAPSE/sPAP ratio (1.36 ± 0.15 vs. 1.82 ± 0.18 mm/mmHg, p < 0.001). Conclusions: Endovenous RFA is associated with favorable changes in right heart parameters. Eliminating pathologic extremity blood pooling may optimize venous return kinetics and subclinically improve right ventricular–pulmonary arterial coupling. Full article

Background: Urosepsis is a life-threatening condition accounting for approximately 20–30% of all sepsis cases and typically arises from ascending infection by uropathogenic Escherichia coli (UPEC). Disease progression is mediated by virulence factors, including adhesins, iron acquisition systems, and toxins. Among these, P fimbriae, particularly papGII adhesin subunit, have been implicated in the transition from uncomplicated urinary tract infection (UTI) to severe urosepsis. This study aimed to evaluate whether papGII carriage, alone or in combination with other UPEC virulence determinants and clinical risk factors, can predict urosepsis. Methods: A total of 60 paired Escherichia coli isolates from concurrent blood and urine samples of adults with clinical sepsis were collected between January and June 2024. Control isolates were obtained from patients with cystitis (n = 28) and pyelonephritis (n = 32). Polymerase chain reaction (PCR) assays were used to detect fifteen virulence-associated genes, including the pap operon (with papG allelic variants), the type 1 fimbriae (fimH), S fimbriae (sfaS), curli fimbriae (csgA), afa/Dr adhesin operon genes, cytotoxic necrotizing factor 1 (cnf1), and the aerobactin biosynthesis (iucD) and receptor (iutA) genes. Associations between gene carriage and clinical groups were analyzed using chi-square tests. Results: The incidence of urosepsis increased with age, peaking in the 60–69-year age group. Renal disease and catheterization were identified as significant risk factors (p < 0.05). More than 95% of UPEC isolates carried the csgA gene associated with biofilm formation and the iucD gene. The α- hemolysin toxin (hlyA) was significantly associated with urosepsis [X²(1, N = 120) = 6.62, p = 0.03]. No significant differences were observed in the carriage of papA, papC, or fimH. Although papGII was present in 65% of urosepsis-associated UPEC isolates, it did not demonstrate a statistically significant independent association with urosepsis [p = 0.1]. Conclusion: This study demonstrates that while papGII may contribute to the pathogenic potential of UPEC and facilitate systemic infection, it is not a reliable independent predictor of urosepsis. Full article

Background: Cervical cancer is among the most common cancers affecting women worldwide, with high morbidity and mortality in low- and middle-income countries. In Saudi Arabia, most cases are diagnosed at a late stage despite the availability of free HPV vaccination and screening. Objectives: To identify Saudi women’s perceptions of the HPV vaccine using the Health Belief Model, estimate willingness to receive the HPV vaccine and the factors influencing it, assess uptake of Pap smear and HPV vaccine, and define barriers to both practices. Methodology: A cross-sectional study of a convenience sample of 1334 Saudi women aged 16 to 65 years, from all regions of Saudi Arabia, was conducted. Data were collected via an online questionnaire that included sociodemographic characteristics, beliefs about the HPV vaccine based on the Health Belief Model, vaccine hesitancy, and HPV vaccine and Pap smear uptake. Data were analyzed using SPSS version 29. Results: Only 6% completed their vaccination series or received at least one dose; 37.3% planned to get vaccinated; and 56.7% stated they do not intend to get vaccinated. The main reasons for vaccine refusal were lack of trust (41.8%) and fear of side effects (32.3%). Only 21% had undergone Pap smear testing, with barriers including embarrassment and fear. Among the HBM constructs, perceived susceptibility, benefits, and barriers remained statistically significant predictors of HPV vaccination. Increased perceived susceptibility and benefits raise the likelihood of accepting the HPV vaccine, while higher perceived barriers lessen it. Vaccine hesitancy had a significant negative effect on willingness to receive the HPV vaccine (OR = 0.78, 95% CI 0.69–0.90, p < 0.01). Additionally, Pap smear uptake was an independent predictor of the intent to get the HPV vaccine (OR = 1.78, 95% CI 1.25–2.54, p < 0.01). The independent factors influencing HPV vaccine uptake were largely similar to those affecting the willingness to receive the vaccine, except for age, perceived benefits, and Pap smear uptake. Conclusions: There is a gap between Saudi women’s intention to get HPV vaccinated and actual vaccination. Women who saw a high risk of HPV-related cancer, believed in vaccine efficacy, had a Pap smear, and were open to vaccination were more likely to vaccinate. Hesitant women and those perceiving barriers were less likely to vaccinate or consider it. The main gaps for future campaigns are perceptions of HPV severity and cultural factors influencing decision-making. Emphasizing HPV as a cancer-related virus rather than a sexually transmitted infection can reduce barriers and highlight its severity. Full article

Although rural livelihoods act as a critical mediator between poverty alleviation policies and sustainable outcomes, the spatial heterogeneity of this interaction remains underexplored within those agrarian systems that are crucial for food production. This study examines how China’s Targeted Poverty Alleviation policies shape livelihood strategies and the livelihood diversity of rural households across different spatial contexts in Jilin Province, a main grain production region of Northeast China. Using survey data from 2306 households, this study employs multiple logistic and linear regression models. The results indicate that (1) industrial and employment policies are associated with development-oriented strategies, whereas enterprise-driven and cash transfer policies tend to reinforce asset-based or welfare-dependent livelihoods; (2) these policy effects exhibit significant spatial heterogeneity, mediated by local agricultural productivity conditions, labor endowments, and off-farm livelihood availability; and (3) industrial policies show stronger associations with agricultural livelihoods in the east, while financial policies are more effective in sustaining agricultural engagement in the capital-constrained west. Integrating the Sustainable Livelihoods Framework with a spatial lens, this study shifts the focus of policy assessment from static outcome metrics to process-oriented analysis and reveals the mechanisms underlying the spatial divergence of livelihood strategies, providing a nuanced analytical framework for assessing the impacts of PAPs across diverse agricultural contexts. Based on these findings, this study highlights that spatially differentiated, livelihood context-sensitive policies are essential for securing sustainable and long-term poverty reduction in grain production regions, offering a replicable template for policy evaluation and practical implications for achieving SDGs 1 and 2 in agrarian regions. Full article

Background: The TRI-SCORE was developed to predict mortality after tricuspid valve surgery and has demonstrated prognostic value in patients undergoing transcatheter tricuspid valve interventions (TTVI). Right ventricular–pulmonary arterial (RV–PA) uncoupling assessed by the TAPSE/sPAP ratio has emerged as a prognostic marker in selected populations; however, its incremental value within established risk scores remains unclear. Methods: In this prospective single-centre cohort, 109 patients undergoing TTVI were included. The original TRI-SCORE was calculated for all patients. A modified TRI-SCORE was proposed by substituting the definition of right ventricular dysfunction based on TAPSE with RV–PA uncoupling, defined as TAPSE/sPAP <0.406 using invasively measured systolic pulmonary artery pressure. The endpoints were 12-month all-cause mortality and a combined endpoint of death or cardiovascular rehospitalization. Results: At 12 months, all-cause mortality occurred in 19.3% of patients, and the combined endpoint in 40.4%. Both original and modified TRI-SCOREs were significantly associated with 12-month mortality (OR 1.80 per point increase, 95% CI 1.30–2.48; p < 0.001 and OR 1.81 per point increase, 95% CI 1.31–2.49; p < 0.001, respectively) and demonstrated comparable discrimination (AUC 0.78 for both; DeLong p = 0.90). Furthermore, both scores were significantly associated with the combined endpoint (TRI-SCORE: OR 1.36 per point increase, 95% CI 1.08–1.71; p = 0.008; modified TRI-SCORE; OR of 1.33 per one-point increase, 95% CI 1.07–1.66; p = 0.009) with modest and comparable AUCs (~0.65). Conclusion: In patients undergoing TTVI, replacing TAPSE with RV–PA uncoupling did not improve the prognostic performance of the TRI-SCORE for mortality or combined clinical outcomes. Full article

Background: Intermediate-high-risk acute pulmonary embolism (APE) presents a clinical challenge, as patients are hemodynamically stable at admission yet carry a substantial risk of deterioration requiring rescue thrombolytic therapy. This study evaluated whether admission complete blood count-derived inflammatory indices, particularly the Systemic Inflammation Response Index (SIRI), are associated with subsequent thrombolytic therapy requirement. Methods: In this retrospective cohort study, 134 patients with computed tomography pulmonary angiography–confirmed intermediate-high-risk APE, classified according to 2019 ESC guidelines, were grouped based on the need for rescue thrombolytic therapy (n = 52) versus no thrombolytic therapy (n = 82). Inflammatory indices were calculated from admission blood samples, and multivariable logistic regression and ROC analyses were performed. Results: Patients requiring thrombolysis had significantly higher SIRI, SII, hs-troponin I, and systolic pulmonary artery pressure (SPAP), and lower lymphocyte counts. In multivariable analysis, SIRI (OR = 2.08, 95% CI 1.37–3.13), SPAP (OR = 1.21, 95% CI 1.06–1.37), and troponin (OR = 1.01 per 10 ng/L increment, 95% CI 1.00–1.01) were independently associated with thrombolytic therapy requirement. Conclusions: SIRI, SPAP, and hs-troponin I were independently associated with thrombolytic therapy requirement in intermediate-high-risk APE. These findings are hypothesis-generating and warrant prospective validation before clinical implementation. Full article

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) ≥ 1.5 and a right ventricular/left ventricular (RV/LV) ratio > 1. ECG parameters, including right bundle branch block (RBBB), right axis deviation, V1–V2 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 ≥ 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]: 2.82–38.20, p < 0.001) and showed good discriminatory performance for RV dilatation (area under the curve [AUC]: 0.881, 95% CI: 0.831–0.932). 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. Full article