An Integrated Heart Sound–Electrocardiogram Synchronization System for Early Detecting Left Ventricular Systolic Dysfunction in Pediatric Populations

ABSTRACT Background Early detection of pediatric left ventricular systolic dysfunction (LVSD) remains challenging in resource‐limited settings. This study evaluates a novel synchronized heart sound‐electrocardiogram (HS‐ECG) system for LVSD detection in underserved pediatric populations. Hypothesis Cardiac acoustic biomarkers (CABs) enable age‐specific early detection of pediatric LVSD. Methods This prospective cohort study enrolled 212 children aged 3–16 years, classified into case (LVEF ≤ 55%, n = 80) and control (LVEF > 55%, n = 132) groups with age stratification (3–6 and 7–16 years). All underwent synchronized HS–ECG recording using a high‐fidelity wearable device. Signals were processed via wavelet analysis to derive CABs including electromechanical activation time (EMAT), pre ‐ ejection period (PEP), left ventricular ejection time (LVET), left ventricular systolic time (LVST), their rate‐corrected values (EMATc, PEPc, LVETc, LVSTc), and the PEP/LVET ratio. Echocardiographic LVEF served as the reference standard. Results In children aged 3–6 years, EMATc showed strong inverse correlation with LVEF (r = −0.529, p < 0.001) and AUC = 0.821 (cutoff: 11.80%; sensitivity 82.5%, specificity 84.7%). In those aged 7–16 years, EMAT demonstrated superior performance (r = −0.609, p < 0.001; AUC = 0.896; cutoff: 82.50 ms; sensitivity 82.5%, specificity 93.2%). Conclusion The synchronized HS‐ECG system provides clinically valuable biomarkers for pediatric LVSD diagnosis, demonstrating distinct age‐dependent diagnostic patterns: EMATc shows optimal performance in younger children (3–6 years), while EMAT exhibits superior efficacy in older children (7–16 years).