Evidence map›Paper›PMID 41549188›Full record

ArticleThe international journal of cardiovascular imaging2026

Echocardiographic Pulmonary to Left Atrial Ratio (ePLAR) as novel non-invasive parameter for elevated pulmonary vascular resistance in adults with unrepaired atrial septal defect.

Nadine Nurani Shabrina, Charlotte Johanna Cool, Mohammad Iqbal

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Article in The international journal of cardiovascular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

3 authors.

Nadine Nurani ShabrinaDepartment of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia. nadinenuranis@gmail.com.
Charlotte Johanna CoolDepartment of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.
Mohammad IqbalDepartment of Cardiology and Vascular Medicine, Faculty of Medicine, University of Padjadjaran, Bandung, Indonesia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The accurate evaluation of pulmonary vascular resistance (PVR) is critical for evaluating operability and guiding management in adults with unrepaired atrial septal defect (ASD). Non-invasive echocardiographic markers, such as the echocardiographic Pulmonary to Left Atrial Ratio (ePLAR), calculated by dividing the peak tricuspid regurgitation velocity (TR Vmax) by the ratio of the transmitral E-wave to mitral annular e' velocity, may facilitate early risk stratification and reduce reliance on invasive procedures. Eighty-nine adult patients with unrepaired ASD underwent comprehensive echocardiography and right heart catheterization. ePLAR and additional echocardiographic parameters were measured, and their ability to identify elevated PVR (≥5 Wood Units, WU) was assessed through correlation and receiver operating characteristic (ROC) analysis. PVR ≥ 5 group showed elevated ePLAR (0.41 vs. 0.29, p < 0.0001. ePLAR showed moderate ability to predict elevated PVR (AUC 0.754). The TR Vmax/ right ventricular outflow tract velocity-time integral (RVOT VTI) and TR Vmax²/RVOT VTI ratio demonstrated stronger discrimination (AUC 0.907 and 0.929). DeLong's test confirmed TR Vmax/RVOT VTI superiority (p = 0.0147). TRVmax/ right ventricular global longitudinal strain (RV GLS) shown to be an ineffective measure (AUC 0.265, p > 0.05). ePLAR is a practical, novel non-invasive echocardiographic parameter for identifying elevated pulmonary vascular resistance in adults with unrepaired ASD. With high sensitivity and independent predictive value, ePLAR is suitable for initial screening and risk stratification, potentially reducing unnecessary invasive testing and improving clinical decision-making.

Indexed as

Atrial Function, LeftEchocardiography, DopplerHeart Septal Defects, AtrialHypertension, PulmonaryPulmonary ArteryPulmonary CirculationVascular ResistanceAdultCardiac CatheterizationFemaleGlobal Longitudinal StrainHumansMaleMiddle AgedPredictive Value of TestsReproducibility of ResultsAdult congenital heart diseaseAtrial septal defectEchocardiographyePLARPulmonary vascular resistance

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.