Predictive values of the electrocardiogram in diagnosing pulmonary hypertension

Al-Naamani, Khalid; Hijal, Tarek; Nguyen, Viviane; Andrew, Steve; Nguyen, Tarn; Huynh, Thao

doi:10.1016/j.ijcard.2007.06.005

Cited by 61 publications

(50 citation statements)

References 13 publications

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“…had superior PPVs for PH: R wave in the I lead <0.2 mV, S wave in lead V1<0.2 mV, R/S in lead V1>1, R/S in lead V6>1, RAD >110 degrees, and the presence of the qR pattern in lead V1 (16). In the present study, among these variables, we found that the presence of the qR pattern in lead V1 and R/S>1 in lead V1 were significant PPV findings of RVSD.…”

Section: Discussionmentioning

confidence: 99%

Significance of Electrocardiographic Right Ventricular Hypertrophy in Patients with Pulmonary Hypertension with or without Right Ventricular Systolic Dysfunction

et al. 2012

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Objective We sought to determine the value of electrocardiographic right ventricular hypertrophy (ECG-RVH) in pulmonary hypertension (PH) patients with right ventricular systolic dysfunction defined by cardiac magnetic resonance (CMR-RVSD). Patients A total of 31 consecutive patients with PH with a mean pulmonary arterial pressure of >25 mmHg underwent both ECG and CMR studies. Patients were divided into 2 groups according to the presence of RVSD, defined as a RV ejection fraction <35%. Logistic regression modeling was performed to define the association between ECG-RVH and CMR-RVSD. Results About half of the patients had RVSD (n=15 ; 48%). The R to S wave ratio (p=0.01) or incidence of qR pattern (p=0.002) in lead V1 was significantly greater in patients with PH complicated by RVSD than in those without RVSD. These 2 patterns were significant predictors of RVSD [odds ratio (OR), 19.3 for qR; OR, 14.0 for R/S>1] and when each of these ECG findings was assigned with a point proportional to OR (score of 2 for qR in lead V1 and score of 1 for R/S>1 in lead V1), the incidence of RVSD increased by the total ECG score. Conclusion The combination of ECG-RVH findings, especially in lead V1, predicts the presence of RVSD defined by CMR. ECG might be a useful tool for estimating the presence of RVSD in patients with PH.

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Section: Discussionmentioning

confidence: 99%

Significance of Electrocardiographic Right Ventricular Hypertrophy in Patients with Pulmonary Hypertension with or without Right Ventricular Systolic Dysfunction

et al. 2012

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“…Right ventricular strain was assessed by a score (RV-score) in which each of the following criteria when exceeded contributed one scoring unit: R in V 1 N 0.7 mV, S in V 1 b 0.2 mV, R/S in V 1 N 1, R/S in V 6 b 1, (R in V 1 + S in V 5 ) N 1 mV, R in I b 0.2 mV, R in V 5 b 0.5 mV, R in aVR N 0.5 mV, (S in I + Q in III) N 0.15 mV and negative T in III, negative T in V 2 and in V 3 , QRS axis N 110°, P in II N 0.25 mV, S in V 6 N 0.7 mV, qR in V 1 , Rsr in V 1 with R N 1 mV [9].…”

Section: A Conventional Ecg Parametersmentioning

confidence: 97%

High resolution ECG-aided early prognostic model for comatose survivors of out of hospital cardiac arrest

Rauber¹,

Štajer²,

Noč³

et al. 2015

Journal of Electrocardiology

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“…lead V6 !1, QRS axis "110°, and qR in V1 had superior PPVs for PH. 8) Kopec, et al also demonstrated that an R wave in lead V1 had the best correlation with RVH among the ECG voltage criteria because V1 is the closest lead to the RV. 9) Given that an R/S ratio "1 in lead V1 is observed in only 1% of patients as a normal variant, 21) these findings suggest that a higher R wave in lead V1 is a useful parameter for detecting PH or RVH.…”

Section: )mentioning

confidence: 95%

“…Naamani, et al reported that the prevalence of ECG criteria for RVH in PH patients was only 1.1-13.5%. 8) Kopec, et al reported that the prevalence of ECG criteria for RVH in idiopathic pulmonary arterial hypertension (IPAH) patients was 6.7-75%. 9) Thus, the ECG criteria may not have sufficient sensitivity to serve as an effective screening tool for PH, especially mild PH.…”

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confidence: 99%

Deeper S Wave in Lead V5 and Broader Extent of T Wave Inversions in the Precordial Leads are Clinically Useful Electrocardiographic Parameters for Predicting Pulmonary Hypertension

et al. 2018

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SummaryElectrocardiography (ECG) is used to screen for pulmonary hypertension (PH). However, it is unclear which parameters of ECG are the most useful for screening.ECG parameters related to right ventricular hypertrophy criteria were examined in 145 ECGs of subjects who were suspected to have PH and underwent right heart catheterization (RHC) (age 58.4 ± 17.5 years, 112 women, mean pulmonary arterial pressure [MPAP] 35.4 ± 13.3 mmHg). Based on the results of RHC, 108 subjects had PH (56 pulmonary arterial hypertension [PAH] and 52 chronic thromboembolic pulmonary hypertension [CTEPH]).Fourteen of 17 ECG parameters in the present study were significantly associated with PH on univariate analysis. On multivariable logistic regression analysis, S wave depth in lead V5 (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.10-1.47) and depth of T wave inversion in lead V4 (OR 1.21, 95% CI 1.03-1.46) were independent predictors of MPAP !25 mmHg, and the cut-off values determined by receiver operating characteristic curve analyses were 0.42 mV and -0.28 mV, respectively.In conclusion, a deeper S wave in lead V5 and the presence of a wider extent of negative T waves in the precordial leads may be clinically simple and useful ECG parameters for screening for PH.(Int Heart J 2018; 59: 136-142) Key words: Pulmonary arterial hypertension, Chronic thromboembolic pulmonary hypertension P ulmonary hypertension (PH) causes pressure overload of the right ventricle (RV) with RV hypertrophy and dilatation, leading to right heart failure and premature death. Despite recent advances in management, the prognosis of PH patients is still poor, with a 3-year survival rate of 67%.

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Predictive values of the electrocardiogram in diagnosing pulmonary hypertension

Cited by 61 publications

References 13 publications

Significance of Electrocardiographic Right Ventricular Hypertrophy in Patients with Pulmonary Hypertension with or without Right Ventricular Systolic Dysfunction

Significance of Electrocardiographic Right Ventricular Hypertrophy in Patients with Pulmonary Hypertension with or without Right Ventricular Systolic Dysfunction

High resolution ECG-aided early prognostic model for comatose survivors of out of hospital cardiac arrest

Deeper S Wave in Lead V5 and Broader Extent of T Wave Inversions in the Precordial Leads are Clinically Useful Electrocardiographic Parameters for Predicting Pulmonary Hypertension

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