Prolonged QRS duration as a predictor of right ventricular dysfunction after balloon pulmonary angioplasty

Asano, Ryotaro; Ogo, Takeshi; Ohta‐Ogo, Keiko; Fukui, Shigefumi; Tsuji, Akiko; Ueda, Jin; Konagai, Nao; Fukuda, Tsuyoshi; Morita, Yoshiaki; Noguchi, Teruo; Kusano, Kengo; Anzai, Toshihisa; Ishibashi‐Ueda, Hatsue; Yasuda, Satoshi

doi:10.1016/j.ijcard.2018.11.026

Cited by 21 publications

(13 citation statements)

References 35 publications

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“…For the QRS complex, the value of the change in the axis was confirmed in patients with CTEPH after the application of hemodynamically effective interventional therapy (Nishiyama et al, 2018). Similarly, the duration of the QRS complex concerning the prognosis was well‐documented in the CTEPH patients (Asano et al, 2019). In our study, the QRS complex axis is the second variable whose value changed significantly not only in the long‐term model, but also during the acute hemodynamic improvement.…”

Section: Discussionmentioning

confidence: 81%

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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Section: Discussionmentioning

confidence: 81%

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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“…In the present study, T1 values of the septum, VIPs, and RV free wall were higher in patients with PAH compared with healthy controls, and the finding is consistent with that in a previous study [ 12 ]. We further found that T1 values of the RV free wall correlated positively with prolonged QRS duration, which is a predictor of RV fibrosis [ 25 ]. Taken together, these findings suggest that native T1 mapping could be used to characterize advanced RV myocardial changes.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of right ventricular native T1 mapping in pulmonary arterial hypertension

et al. 2021

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Background Right ventricular function is an important prognostic marker for pulmonary arterial hypertension. Native T1 mapping using cardiovascular magnetic resonance imaging can characterize the myocardium, but accumulating evidence indicates that T1 values of the septum or ventricular insertion points do not have predictive potential in pulmonary arterial hypertension. We aimed to elucidate whether native T1 values of the right ventricular free wall (RVT1) can predict poor outcomes in patients with pulmonary arterial hypertension. Methods This retrospective study included 30 patients with pulmonary arterial hypertension (median age, 45 years; mean pulmonary artery pressure, 41±13 mmHg) and 16 healthy controls (median age, 43 years) who underwent native T1 mapping. RVT1 was obtained from the inferior right ventricular free wall during end systole. Results Patients with pulmonary arterial hypertension had significantly higher native RVT1 than did controls (1384±74 vs. 1217±57 ms, p<0.001). Compared with T1 values of the septum or ventricular insertion points, RVT1 correlated better with the effective right ventricular elastance index (R = −0.53, p = 0.003), ventricular-arterial uncoupling (R = 0.46, p = 0.013), and serum brain natriuretic peptide levels (R = 0.65, p<0.001). Moreover, the baseline RVT1 was an accurate predictor of the reduced right ventricular ejection fraction at the 12-month follow-up (delta -3%). RVT1 was independently associated with composite events of death or hospitalization from any cause (hazard ratio = 1.02, p = 0.002). Conclusions RVT1 was predictive of right ventricular performance and outcomes in patients with pulmonary arterial hypertension. Thus, native T1 mapping in the right ventricular free wall may be an effective prognostic method for pulmonary arterial hypertension.

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“…In the present study, the RV1 peak > 0.035 s (QRS < 120 ms) presented discriminative ability (AUC 0.655) for CTEPH localization. Recently, Asano et al showed that the QRS duration correlated with the area of fibrosis in the RV [32]. Similarly, Kopeć et al also revealed the utility of the ventricular activation time in V1 in RVH diagnosis in PAH (AUC 0.83).…”

Section: Discussionmentioning

confidence: 94%

Association of Electrocardiographic Signs of Right Ventricular Hypertrophy and Clot Localization in Chronic Thromboembolic Pulmonary Hypertension

Sławek-Szmyt

Araszkiewicz

Jankiewicz

et al. 2022

JCM

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The role of electrocardiography (ECG) in chronic thromboembolic pulmonary hypertension (CTEPH) diagnosis and prognosticating has not been yet established. We aimed to assess the relationships of the recommended ECG criteria of right ventricular hypertrophy (RVH) with clot localization in CTEPH patients. ECG patterns of RVH according to the American College of Cardiology Foundation were assessed in patients with newly diagnosed CTEPH. We enrolled 58 (45.3%) patients with proximal and 70 (54.7%) with distal CTEPH. Receiver-operating characteristics curves analysis indicated that the following ECG abnormalities predicted proximal CTEPH localization: RV1 > 6 mm—AUC 0.75 (CI: 0.66–0.84, p < 0.00001); SV6 > 3 mm—AUC 0.70 (CI: 0.60–0.79, p < 0.00001); SI > RI wave—AUC 0.67 (CI: 0.58–0.77, p = 0.0004); RV1:SV1 > 1.0—AUC 0.66 (CI: 0.56–0.76, p = 0.0009); RV1 peak > 0.035 s (QRS < 120 ms)—AUC 0.66 (CI: 0.56–0.75, p = 0.0016); RV1:SV1 > RV3(V4):SV3(V4)—AUC-0.65 (CI: 0.54–0.75, p = 0.0081); RaVR > 4 mm—AUC 0.62 (CI: 0.52–0.71, p = 0.002) and PII > 2.5 mm—AUC 0.62 (CI: 0.52–0.72, p = 0.00162). Pulmonary vascular resistance significantly correlated with amplitudes of RV1 (r = 0.34, p = 0.008), SV6 (r = 0.53, p = 0.000027) and PII (r = 0.44, p = 0.00007). In patients with CTEPH, only 8 out of 23 ECG RVH criteria were useful for differentiating between proximal and distal CTEPH localization and we found that RV1 and SV6 may contribute as potential discriminators.

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Prolonged QRS duration as a predictor of right ventricular dysfunction after balloon pulmonary angioplasty

Cited by 21 publications

References 35 publications

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

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

Prognostic value of right ventricular native T1 mapping in pulmonary arterial hypertension

Association of Electrocardiographic Signs of Right Ventricular Hypertrophy and Clot Localization in Chronic Thromboembolic Pulmonary Hypertension

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