Prevalence and predictive value of electrocardiographic abnormalities in pulmonary hypertension: evidence from the Pan-African Pulmonary Hypertension Cohort (PAPUCO) study

Abstract

SummaryBackgroundPulmonary hypertension (PH) is prevalent in Africa and is still often diagnosed only at an advanced stage, therefore it is associated with poor quality of life and survival rates. In resource-limited settings, we assessed the diagnostic utility of standard 12-lead electrocardiograms (ECG) to detect abnormalities indicating PH.MethodsSixty-five patients diagnosed with PH were compared with 285 heart disease-free subjects. The prevalence and diagnostic performance of ECG features indicative of PH and right heart strain were calculated.ResultsCompared to the control group, all abnormalitieswere more frequent in the PH cohort where no patient hada completely normal ECG. The most prevalent (cases vscontrol) ECG abnormalities were: pathological Q wave inat least two contiguous peripheral leads (47.7 vs 6.7%), leftventricular hypertrophy (38.5 vs 9.8%) and p-pulmonale(36.9 vs 20.7%) (all p < 0.05). The sensitivity of ECG criteriafor right heart strain ranged between 6.2 and 47.7%, whilespecificity ranged between 79.3 and 100%. Negative predictivevalue ranged between 81.5 and 88.9% and positive predictivevalue between 25 and 100%. Positive predictive value waslowest (25%) for right bundle branch block and QRS rightaxisdeviation (≥ 100°), and highest (100%) for QRS axis ≥+100° combined with R/S ratio in V1 ≥ 1 or R in V1 > 7 mm.ConclusionWhen present, signs of PH on ECG strongly indicated disease, but a normal ECG cannot rule out disease. ECG patterns focusing on the R and S amplitude in V1 and right-axis deviation had good specificity and negative predictive values for PH, and warrant further investigation with echocardiography.

Long-Term Follow-up of Human Immunodeficiency Virus-Associated Pulmonary Hypertension: Clinical Features and Survival Outcomes of the Pan Africa Pulmonary Hypertension Cohort (PAPUCO)

“…This study describes the baseline characteristics, analyses, and long-term outcome among Black African HIV-infected versus HIV-uninfected patients with PH included in the PAPUCO registry. The PAPUCO represents the largest prospective longitudinal study on patients diagnosed with PH in SSA, and the main results have been previously published [ 12 , 16 , 17 ]. It provides important insights into the clinical profile and treatment of PH from a uniquely African context [ 12 ].…”

“…The ECG and echocardiography are valuable diagnostic procedures for HIV-infected patients who are at high risk of heart and pulmonary disease. Reflecting on the high burden of TB-HIV coinfection in SSA, we advocate for further debates with regards to the implementation of ECG and echocardiography screening among at-risk HIV patients, which includes patients with previous episodes of TB [ 3 , 16 ].…”

Moving Ahead

“…Leading by example is one of the goals for the active mentoring of junior female colleagues. The PAPUCO project promoted the involvement of established and young female researchers who have led study implementation in their countries, resulting in publications with balanced gender representation and women in leading roles (12) . In 2016, Sliwa and Ana Mocumbi started a formal collaboration between their 2 teams at the Hatter Institute for Cardiovascular Research in Africa (Cape Town, South Africa) and the National Health Institute (Mozambique).…”