Computerized Tomographic Quantification of Chronic Obstructive Pulmonary Disease as the Principal Determinant of Frontal P Vector

Chhabra, Lovely; Sareen, Pooja; Gandagule, Amit; Spodick, David H.

doi:10.1016/j.amjcard.2011.11.036

Cited by 12 publications

(6 citation statements)

References 17 publications

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“…Verticalization of the P wave axis in COPD has been reported [8–10], as well as a positive correlation between the P wave vector and radiographic evidence of emphysema [11]. Increased heart rate is a common finding in COPD and linked to its severity and prognosis [12].…”

Section: Introductionmentioning

confidence: 99%

Effects of airway obstruction and hyperinflation on electrocardiographic axes in COPD

et al. 2019

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Background COPD influences cardiac function and morphology. Changes of the electrical heart axes have been largely attributed to a supposed increased right heart load in the past, whereas a potential involvement of the left heart has not been sufficiently addressed. It is not known to which extent these alterations are due to changes in lung function parameters. We therefore quantified the relationship between airway obstruction, lung hyperinflation, several echo- and electrocardiographic parameters on the orientation of the electrocardiographic (ECG) P, QRS and T wave axis in COPD. Methods Data from the COPD cohort COSYCONET were analyzed, using forced expiratory volume in 1 s (FEV 1 ), functional residual capacity (FRC), left ventricular (LV) mass, and ECG data. Results One thousand, one hundred and ninety-five patients fulfilled the inclusion criteria (mean ± SD age: 63.9 ± 8.4 years; GOLD 0–4: 175/107/468/363/82). Left ventricular (LV) mass decreased from GOLD grades 1–4 ( p = 0.002), whereas no differences in right ventricular wall thickness were observed. All three ECG axes were significantly associated with FEV 1 and FRC. The QRS axes according to GOLD grades 0–4 were (mean ± SD): 26.2° ± 37.5°, 27.0° ± 37.7°, 31.7° ± 42.5°, 46.6° ± 42.2°, 47.4° ± 49.4°. Effects of lung function resulted in a clockwise rotation of the axes by 25°-30° in COPD with severe airway disease. There were additional associations with BMI, diastolic blood pressure, RR interval, QT duration and LV mass. Conclusion Significant clockwise rotations of the electrical axes as a function of airway obstruction and lung hyperinflation were shown. The changes are likely to result from both a change of the anatomical orientation of the heart within the thoracic cavity and a reduced LV mass in COPD. The influences on the electrical axes reach an extent that could bias the ECG interpretation. The magnitude of lung function impairment should be taken into account to uncover other cardiac disease and to prevent misdiagnosis. Electronic supplementary material The online version of this article (10.1186/s12931-019-1025-y) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Effects of airway obstruction and hyperinflation on electrocardiographic axes in COPD

et al. 2019

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“…Moreover, increasing verticality of the frontal P vector correlates with increasing degrees of airway obstruction,8,9 degree of depression of the diaphragm,3 and radiographic quantification of the disease 12,13. A possible mechanism of P wave axis verticalization in lung hyperinflation is that the right atrium is firmly attached to the diaphragm by a dense pericardial ligament around the inferior vena cava 3.…”

Section: Discussionmentioning

confidence: 99%

“…In previous investigations, we have determined that a vertical P wave axis (>60 degrees) during sinus rhythm can be used as a lone criterion to screen for pulmonary hyperinflation/emphysema, with sensitivity and specificity both being above 90% 4,5,8. Previous studies have also suggested that the degree of P vector verticalization has an inverse correlation with qualitative lung function8,9 and quantification of radiographic emphysema 12,13. A vertical P vector on a surface 12-lead electrocardiogram can be determined by two methods using limb leads, ie, a P wave amplitude in lead III greater than in lead I or a negative P wave in aVL,1,5,8 although both these electrocardiographic findings suggest a vertical P vector and theoretically both should be simultaneously present in all the patients with a vertical P vector.…”

Section: Introductionmentioning

confidence: 99%

Optimal electrocardiographic limb lead set for rapid emphysema screening

Bajaj¹,

Chhabra²,

Basheer³

et al. 2013

COPD

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BackgroundPulmonary emphysema of any etiology has been shown to be strongly and quasidiagnostically associated with a vertical frontal P wave axis. A vertical P wave axis (>60 degrees) during sinus rhythm can be easily determined by a P wave in lead III greater than the P wave in lead I (bipolar lead set) or a dominantly negative P wave in aVL (unipolar lead set). The purpose of this investigation was to determine which set of limb leads may be better for identifying the vertical P vector of emphysema in adults.MethodsUnselected consecutive electrocardiograms from 100 patients with a diagnosis of emphysema were analyzed to determine the P wave axis. Patients aged younger than 45 years, those not in sinus rhythm, and those with poor quality tracings were excluded. The electrocardiographic data were divided into three categories depending on the frontal P wave axis, ie, >60 degrees, 60 degrees, or <60 degrees, by each criterion (P amplitude lead III > lead I and a negative P wave in aVL).ResultsSixty-six percent of patients had a P wave axis > 60 degrees based on aVL, and 88% of patients had a P wave axis > 60 degrees based on the P wave in lead III being greater than in lead I.ConclusionA P wave in lead III greater than that in lead I is a more sensitive marker than a negative P wave in aVL for diagnosing emphysema and is recommended for rapid routine screening.

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“…Previous studies have shown that the vertical P-vector is not only the most sensitive but also a highly specific criterion for rapid bedside screening for emphysema in the general hospitalized population 4–6. Moreover, a vertical P-vector also bears an inverse correlation with the severity of obstructive lung dysfunction (forced expiratory volume in one second, FEV 1 ) and radiographic severity of emphysema 9,10. A vertical P-vector has a sensitivity and specificity ranging from 82.1% to 96% and from 86.4% to 96%, respectively, for diagnosing emphysema 4,6,11–13…”

Section: Introductionmentioning

confidence: 99%

Diagnostic electrocardiographic dyad criteria of emphysema in left ventricular hypertrophy

Lanjewar¹,

Chhabra²,

Chaubey³

et al. 2013

COPD

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BackgroundThe electrocardiographic diagnostic dyad of emphysema, namely a combination of the frontal vertical P-vector and a narrow QRS duration, can serve as a quasidiagnostic marker for emphysema, with specificity close to 100%. We postulated that the presence of left ventricular hypertrophy in emphysema may affect the sensitivity of this electrocardiographic criterion given that left ventricular hypertrophy generates prominent left ventricular forces and may increase the QRS duration.MethodsWe reviewed the electrocardiograms and echocardiograms for 73 patients with emphysema. The patients were divided into two groups based on the presence or absence of echocardiographic evidence of left ventricular hypertrophy. The P-vector, QRS duration, and forced expiratory volume in one second (FEV1) were computed and compared between the two subgroups.ResultsThere was no statistically significant difference in qualitative lung function (FEV1) between the subgroups. There was no statistically significant difference in mean P-vector between the subgroups. The mean QRS duration was significantly longer in patients with left ventricular hypertrophy as compared with those without left ventricular hypertrophy.ConclusionThe presence of left ventricular hypertrophy may not affect the sensitivity of the P-vector verticalization when used as a lone criterion for diagnosing emphysema. However, the presence of left ventricular hypertrophy may significantly reduce the sensitivity of the electrocardiographic diagnostic dyad in emphysema, as it causes a widening of the QRS duration.

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Computerized Tomographic Quantification of Chronic Obstructive Pulmonary Disease as the Principal Determinant of Frontal P Vector

Cited by 12 publications

References 17 publications

Effects of airway obstruction and hyperinflation on electrocardiographic axes in COPD

Effects of airway obstruction and hyperinflation on electrocardiographic axes in COPD

Optimal electrocardiographic limb lead set for rapid emphysema screening

Diagnostic electrocardiographic dyad criteria of emphysema in left ventricular hypertrophy

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