Changes in surface electrocardiogram in patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy. Correlations with hemodynamic and echocardiographic improvements after surgery

Ghio, Stefano; Turco, Annalisa; Klersy, Catherine; Raineri, Claudia; Crescio, Valeria; Viscardi, Arianna; Grazioli, Valentina; Sciortino, Antonio; Visconti, Luigi Oltrona; D’Armini, Andrea Maria

doi:10.1016/j.jelectrocard.2015.12.006

Cited by 16 publications

(23 citation statements)

References 24 publications

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“…In one cohort of 99 patients with CTEPH who underwent pulmonary endarterectomy (PEA), the decrease of P II , R V 1 and normalization of negative T V 1– V 3 were observed 1 month after PEA. Additional changes such as increase of S V 1 , increase of R : S V 6 , and decreased prevalence of S I Q III pattern were observed at 1-year follow-up [ 30 ]. Of these changes only a decrease in P II correlated with lowering of mPAP and PVR.…”

Section: Discussionmentioning

confidence: 99%

ECG Markers of Hemodynamic Improvement in Patients with Pulmonary Hypertension

Waligóra

Tyrka

Podolec

et al. 2018

BioMed Research International

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Introduction Several diagnostic tests have been recommended for risk assessment in pulmonary hypertension (PH), but the role of electrocardiography (ECG) in monitoring of PH patients has not been yet established. Therefore the aim of the study was to evaluate which ECG patterns characteristic for pulmonary hypertension can predict hemodynamic improvement in patients treated with targeted therapies. Methods Consecutive patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) were eligible to be included if they had had performed two consecutive right heart catheterization (RHC) procedures before and after starting of targeted therapies. Patients were followed up from June 2009 to July 2017. ECG patterns of right ventricular hypertrophy according to American College of Cardiology Foundation were assessed. Results We enrolled 80 patients with PAH and 11 patients with inoperable CTEPH. The follow-up RHC was performed within 12.6 ± 10.0 months after starting therapy. Based on median change of pulmonary vascular resistance, we divided our patients into two subgroups: with and without significant hemodynamic improvement. RV1, max⁡RV1,2 + max⁡SI,aVL − SV1, and PII improved along with the improvement of hemodynamic parameters including PVR. They predicted hemodynamic improvement with similarly good accuracy as shown in ROC analysis: RV1 (AUC: 0.75; 95% CI: 0.63–0.84), PII (AUC: 0.67, 95% CI: 0.56–0.77), and max⁡RV1,2 + max⁡SI,aVL − SV1 (0.73; 95% CI: 0.63–0.82). In Cox regression only change in RV1 remained significant mortality predictor (HR: 1.12, 95% CI: 1.01–1.24). Conclusion Electrocardiogram may be useful in predicting hemodynamic effects of targeted therapy in precapillary pulmonary hypertension. Decrease of RV1, max⁡RV1,2 + max⁡SI,aVL − SV1, and PII corresponds with hemodynamic improvement after treatment. Of these changes a decrease of R wave amplitude in V1 is associated with better survival.

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Section: Discussionmentioning

confidence: 99%

ECG Markers of Hemodynamic Improvement in Patients with Pulmonary Hypertension

Waligóra

Tyrka

Podolec

et al. 2018

BioMed Research International

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“…Previous studies also proved that the S -wave amplitude in lead V 1 , the R/S ratio in lead V 6 , and the spreading of the S I Q III complex were changed after PEA, together with the observed reverse right ventricular remodeling assessed on echocardiography. 19 It was also proved that the degree of the right ventricular size reduction was correlated with the change in the cardiac axis and geometry observed on ECG examination. 22,24 Nishiyama et al 12 showed that the treatment of patients with CTEPH with BPA caused the withdrawal of patients with CTEPH who underwent percutaneous treatment and resolution of specific ECG variables of the RVH.…”

Section: Electrocardiographic Hemodynamic and Functionalmentioning

confidence: 90%

“…17 Several previous studies showed that the regression of specific ECG signs of the right ventricular strain or RVH was observed in survivors of acute pulmonary embolism but also in patients with CTEPH after successful PEA and those with pulmonary arterial hypertension treated with specific pharmacotherapy. [18][19][20] It was shown that the presence of the qR complex in lead V 1 , R/S ratio in lead V 1 , and P -wave amplitude in lead II had significant prognostic value in the population of patients with pulmonary hypertension, and some of them might be used to assess the efficacy of the therapy applied. 18,[21][22][23] It has been proved that the said presence of qR complex in lead V 1 reflects the midsystolic dilation and flattening of the right ventricle very well and is an important predictor of mortality in the population of patients with pulmonary hypertension.…”

Section: Electrocardiographic Hemodynamic and Functionalmentioning

confidence: 99%

“…Both previous studies and the present study confirmed the significance of the S wave in lead I, whose amplitude change in our study was correlated with the change in the PVR and mPAP. 12,19 In patients with CTEPH, RBBB associated with RVH is usually related to right ventricle enlargement and a lengthening of the conduction pathway. It should be kept in mind that the size of the right ventricle cavity may be subject to certain dynamics.…”

Section: Electrocardiographic Hemodynamic and Functionalmentioning

confidence: 99%

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The evolution of electrocardiographic signs of right ventricular overload after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Piłka¹,

Darocha²,

Banaszkiewicz³

et al. 2019

Polish Archives of Internal Medicine

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INTRODUCTION Balloon pulmonary angioplasty (BPA) is a treatment option for a patient with chronic thromboembolic pulmonary hypertension. OBJECTIVES We aimed to investigate the evolution of electrocardiographic (ECG) markers of right ventricular hypertrophy (RVH) after BPA. PATIENTS AND METHODS Standard 12-lead ECG was performed in 41 patients with chronic thromboembolic pulmonary hypertension before the first BPA and after completion of treatment. RESULTS In the whole study group, the percentage change in the pulmonary vascular resistance (PVR) after BPA correlated with the percentage change in the values of the following ECG parameters (P <0.05): axis of the QRS (rho = 0.530) and T wave (rho = 0.372); P wave in leads II (rho = 0.340) and III (rho = 0.430); S wave in lead V 5 (rho = 0.634); R/S ratio in lead V 5 (rho =-0.636); S wave in lead V 6 (rho = 0.508); S wave in lead I (rho = 0.496). Then, the group was divided into 2 subgroups: group A, defined as a drop in PVR greater than the median value (49%) for the whole study population; and group B, defined as a drop in PVR below the median value. In group A, the following parameters changed after BPA: T-wave axis (P <0.001), P wave in lead II (P <0.001), S wave in lead V 5 (P <0.001), R/S ratio in lead V 5 (P <0.001). In group B, despite some hemodynamic and functional improvement, there were no differences in ECG markers of RVH after BPA. CONCLUSIONS An improvement in RVH parameters can be observed on ECG after a hemodynamically effective BPA.

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“…The reduction in the P‐wave amplitude was correlated with a reduction in PVR and mPAP; the P‐wave amplitude was one of the few electrocardiographic parameters correlated with PVR and mPAP. P‐wave amplitude, R‐wave amplitude in V 1 , and the number of patients with negative T wave in V 1 –V 3 decreased significantly, with rapid improvement in right heart hemodynamics, 1 month after surgery, without any further change in 1 year (Ghio et al, 2016). In our study, the change in the P‐wave amplitude in II, in the long‐term model, is significantly correlated with changes in the PVR (rho = 0.44), CI (rh = −0.473), TPR (rho = 0.46), and SVI (rho = −0.43) values.…”

Section: Discussionmentioning

confidence: 99%

Assessment of electrocardiographic markers of acute and long‐term hemodynamic improvement in patients with pulmonary hypertension

Piłka¹,

Darocha²,

Banaszkiewicz³

et al. 2020

Noninvasive Electrocardiol

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Background The remodeling of the right heart in patients with chronic pulmonary hypertension (cPH) is associated with the appearance of electrocardiographic (ECG) abnormalities. We investigated the resolution of ECG markers of right ventricular hypertrophy (RVH) caused by acute and long‐term hemodynamic improvement. Methods Twenty‐nine (29) patients with chronic thromboembolic pulmonary hypertension (CTEPH) and seven patients with pulmonary arterial hypertension (PAH) were included in the analysis. Patients with CTEPH achieved a significant long‐term hemodynamic improvement following the treatment with balloon pulmonary angioplasty (BPA); all the patients with PAH reported significant acute hemodynamic relief after a single inhalation of iloprost, fulfilling the criteria of responder. Standard 12‐lead ECG was performed before and after intervention. Results The interval between baseline and control ECG in CTEPH and PAH groups was 28 (IQR: 17–36) months and 15 min (IQR: 11–17), respectively. Despite similar hemodynamic improvement in both groups, only the CTEPH group presented significant changes in most analyzed ECG parameters: T‐wave axis (p = .002), QRS‐wave axis (p = .012), P‐wave amplitude (p < .001) and duration in II (p = .049), R‐wave amplitude in V1 (p = .017), R:S ratio in V1 (p = .046), S‐wave amplitude in V5 (p = .004), R‐wave amplitude in V5 (p = .044), R:S ratio in V5 (p = .004), S‐wave amplitude in V6 (p = .026), R‐wave amplitude in V6 (p = .01), and R‐wave amplitude in aVR (p = .031). In patients with PAH, significant differences were found only for P wave in II (duration: p = .035; amplitude: p = .043) and QRS axis (p = .018). Conclusions The effective treatment of cPH ensures improvement in ECG parameters of RVH, but it requires extended time.

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Changes in surface electrocardiogram in patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy. Correlations with hemodynamic and echocardiographic improvements after surgery

Cited by 16 publications

References 24 publications

ECG Markers of Hemodynamic Improvement in Patients with Pulmonary Hypertension

ECG Markers of Hemodynamic Improvement in Patients with Pulmonary Hypertension

The evolution of electrocardiographic signs of right ventricular overload after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Assessment of electrocardiographic markers of acute and long‐term hemodynamic improvement in patients with pulmonary hypertension

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