A Dynamic Electrocardiographic Concept Useful in the Diagnosis of Cor Pulmonale

Kilcoyne, Margaret M.; Davis, Alison F.; Ferrer, M. Irené

doi:10.1161/01.cir.42.5.903

Cited by 50 publications

(21 citation statements)

References 22 publications

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“…Thus, ECG stability does not exclude hemodynamic aggravation, especially in cases of PAH, but a worsening ECG picture, as defined in this work, almost always indicates worsening of PAH. These results are in general agreement with a previous study [18] limited to cases of CPC, and they illustrate the diag nostic value of ECG follow-up which has been emphasized in recent years [6].…”

Section: Discussionsupporting

confidence: 92%

Clinical, Functional and Pulmonary Hemodynamic Course of Patients with Chronic Obstructive Pulmonary Disease Followed-Up Over 3 Years

Weitzenblum¹,

Hirth²,

Parini³

et al. 1978

Respiration

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In 65 subjects with chronic obstructive pulmonary disease, mainly chronic bronchitics, all exhibiting arterial hypoxemia and moderate to severe airways obstruction (FEV₁ ranging from 625 to 1,980 ml), the following data were regularly followed-up over 3 years: clinical status, chest X-rays, ECG, arterial blood gases, pulmonary volumes, pulmonary hemodynamics (at least two catheterizations were performed). Strasbourg 67000 (France The follow-up period defined by the time elapsed between the first and the last hemodynamic investigation was 57.1 ± 17.4 months, range 36–120 months. 25 patients died after a mean follow-up period of 64.3 ± 21.3 months. 38 patients experienced one or several right heart failure (RHF) episodes. These episodes were significantly more frequent in the decreased patients (3.6 ± 3.3) than in the survivors (1.2 ± 1.6). The pulmonary artery mean pressure (PAP) for the whole group varied little, from 21.0 ± 7.7 to 23.9 ± 9.9 Torr (p < 0.005). PAP increased by more than 5 Torr in 19 cases only. In these cases with hemodynamic ‘worsening’ final PaO₂ was lower (p < 0.001) and final PaCO₂ was higher (p < 0.01) than in patients with hemodynamic ‘stability’. A significant negative correlation was found between chronological changes of P_aO₂ and PAP: r = -0.38, p < 0.01. After RHF episodes, PAP usually returned to its baseline level (6 exceptions for 38 subjects). There was a satisfactory correlation between the hemodynamic (PAP) evolution and clinical, X-rays (transverse heart diameter) and ECG evolution. In cases with ECG worsening (n = 15) the PAP varied significantly from 24.4 ± 4.6 to 34.6 ± 10.6 Torr (p < 0.005). These results emphasize the prognostic value of (irreversible) ECG changes in the course of chronic obstructive pulmonary disease (COPD).

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Section: Discussionsupporting

confidence: 92%

Clinical, Functional and Pulmonary Hemodynamic Course of Patients with Chronic Obstructive Pulmonary Disease Followed-Up Over 3 Years

Weitzenblum¹,

Hirth²,

Parini³

et al. 1978

Respiration

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“…Electrocardiographic changes have been previously reported in COPD patients with cor pulmonale diagnosed clinically or during an autopsy (16, 17, 27-29). The ECG findings suggestive of right ventricular hypertrophy occur late in the course of the disease (16) and are difficult to differentiate from the rotational changes or electrical insulating effects caused by the hyperinflated lungs (17, 30).…”

Section: Discussionmentioning

confidence: 90%

“…However, the ECG findings may be late (16) and not always reliable for this diagnosis (17) due to their poor sensitivity (18-21). ECG abnormalities are more commonly seen in COPD patients than age-matched controls and their prevalence increases with severity of pulmonary obstruction (22).…”

Section: Introductionmentioning

confidence: 99%

Electrocardiographic Differences between COPD Patients Evaluated for Lung Transplantation With and without Pulmonary Hypertension

Alkukhun

Baumgartner

Budev

et al. 2014

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Introduction Pulmonary hypertension (PH) is an indicator of poor prognosis in COPD patients; particularly in those with mean pulmonary artery pressure ≥ 40 mm Hg. Electrocardiography (ECG) might be useful for screening of this condition. Methods Retrospective study of COPD patients evaluated for lung transplantation in whom we analyzed the 12-lead ECG performed closest to the time of right heart catheterization. Results We included 142 patients. PH was present in 90 patients (63 %) and 16 (11%) had a mean PAP ≥ 40 mmHg. The PR interval was longer in PH patients (151 (29) versus 139 (22) ms, p = 0.01) and T wave axis had a left shift (56.9 (32) versus 68.7 (19) degrees, p = 0.006). PR interval was longer (178.5 (35) versus 142.2 (23) ms, p = 0.001), T wave axis had a leftward deflection (63.6 (24) versus 42.8 (46) degrees, p = 0.005) and S wave in lead I was larger (0.19 (0.13) versus 0.12 (0.12) mV, p = 0.03) in patients with mean PAP ≥ 40 mmHg. A PR interval > 137 ms and S wave in DI > 0.02 mV had a sensitivity of 100% and a specificity of 59.5% to identify COPD patients with a mean PAP ≥ 40 mmHg. Conclusion There are significant ECG differences between advanced COPD patients with and without PH; however the ECG is an inadequate tool to differentiate between the groups. A prolonged PR interval suggests the presence of severe PH.

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“…Kilcoyne et al [20] reported that the sensitivity of Sokolow and Lyon [21] was 28% in the patients with cor pulmonale whose ECG showed the pattern of right ven tricular hypertrophy. Walker et al [22] reported that the sensitivity of the ECG criteria proposed by Sokolow and Lyon [21] was 22.7% and that those of Myers et al [23] was 13.6% in autopsy-proven cases of isolated right ven tricular hypertrophy.…”

Section: Diagnosis Of Rvo From the Ecg And Mcgmentioning

confidence: 99%

QRS Wave of the Magnetocardiogram in Right Ventricular Overload: Correlation with Right Ventricular Pressure

Katayama¹,

Nomura²,

Nakaya³

1989

Am J Noninvas Cardiol

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The magnetocardiogram (MCG) using a second derivative gradiometer specificially detects a current source close to the detector, and it should clearly detect the electromotive force of the right ventricle. Therefore, in the present study, we examined the features of the MCG of patients with right ventricular overload. Compared with normal subjects, patients with typical right ventricular overload showed an increased amplitude of the R wave in the upper portion at the anterior chest, and of the S wave in the lower portion. On the basis of mean ± 2 SD of values for normal subjects, the MCG criteria for right ventricular overload were set as follows: (1) R wave at B-2 (R(b-2)) ≥13 × 10^–8 gauss; (2) S wave at F-3 (S(F-3)) ≥3 × 10^–8 gauss; (3) right to left ratio = (R(b-2) + S(f-3))/(S(b-2) + R(f-3)) ≥1.0. In a prospective study, the MCG criteria showed significantly higher sensitivity than the ECG criteria in patients with right ventricular overload, especially in patients with a right ventricular pressure of more than 50 mm Hg. These results suggest that the MCG is useful for diagnosis of right ventricular overload.

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A Dynamic Electrocardiographic Concept Useful in the Diagnosis of Cor Pulmonale

Cited by 50 publications

References 22 publications

Clinical, Functional and Pulmonary Hemodynamic Course of Patients with Chronic Obstructive Pulmonary Disease Followed-Up Over 3 Years

Clinical, Functional and Pulmonary Hemodynamic Course of Patients with Chronic Obstructive Pulmonary Disease Followed-Up Over 3 Years

Electrocardiographic Differences between COPD Patients Evaluated for Lung Transplantation With and without Pulmonary Hypertension

QRS Wave of the Magnetocardiogram in Right Ventricular Overload: Correlation with Right Ventricular Pressure

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