Pediatric Cardiology

, Volume 39, Issue 6, pp 1115–1122 | Cite as

Impact of the Right Ventricular Sokolow–Lyon Index in Children with Idiopathic Pulmonary Arterial Hypertension

  • Johannes Krämer
  • Felix Kreuzer
  • Michael Kaestner
  • Peter Bride
  • Fabian von Scheidt
  • Jannos Siaplaouras
  • Heiner Latus
  • Dietmar Schranz
  • Christian Apitz
Original Article


Right ventricular (RV) hypertrophy is regarded as the adaptation on chronic RV pressure load in pulmonary hypertension. As the RV Sokolow–Lyon index (RVSLI) is an electrocardiographic marker of RV hypertrophy, we hypothesized that RVSLI might be able to reflect RV pressure load. Therefore, the purpose of this study was to characterize the diagnostic impact of the RVSLI in children with idiopathic pulmonary arterial hypertension (IPAH) in order to assess disease severity and to evaluate its value for the prediction of worse outcome. Forty-two children (aged 3–17 years) with IPAH were included in this retrospective study. The follow-up after baseline examination was 59 ± 17 months. Receiver-operating characteristic (ROC) curves and Kaplan–Meier analysis were used to discriminate a cut-off value of RVSLI and to assess its predictive value regarding morbidity and mortality. In 12/42 patients (29%) severe cardiovascular events (defined as death, lung transplantation, or Potts shunt) were observed (time to event 20 ± 22 months). Patients with an event showed higher RVSLI values (3.6 ± 1.2 mV vs. 2.6 ± 1.6 mV; p < 0.05). ROC analysis discriminated an RVSLI of 2.1 as the best cut-off value (area under the ROC curve: 0.79, sensitivity: 0.91, specificity: 0.70, p < 0.05) to detect patients with high-risk PAH (mPAP/mSAP ratio > 0.75). Relative risk for a severe event with an index > 2.1 mV was 1.76 (95% CI 1.21–3.20). Relative risk for death with RVSLI > 2.1 mV was 2.01 (95% CI 1.61–4.80). Our study demonstrates a strong relationship between RVSLI and disease severity in children with IPAH. An RVSLI > 2.1 mV at the time of first diagnosis is a predictor for patients at risk for cardiac events. As an adjunct to the usual diagnostic assessment this parameter may therefore contribute to the initial prognostic estimation.


ECG PAH Pediatric cardiology Right ventricle Hypertrophy Adaptation 


Compliance with Ethical Standards

Conflict of interest

The authors declares that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Johannes Krämer
    • 1
  • Felix Kreuzer
    • 1
  • Michael Kaestner
    • 1
  • Peter Bride
    • 1
  • Fabian von Scheidt
    • 1
  • Jannos Siaplaouras
    • 1
  • Heiner Latus
    • 2
  • Dietmar Schranz
    • 2
  • Christian Apitz
    • 1
    • 2
  1. 1.Division of Pediatric CardiologyUniversity Children’s Hospital UlmUlmGermany
  2. 2.Pediatric Heart CenterUniversity of GiessenGiessenGermany

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