Role of electrocardiographic changes in discriminating acute or chronic right ventricular pressure overload

Abstract

Objective: Pulmonary embolism (PE) and severe pulmonary stenosis (PS) are two distinct conditions accompanied by increased pressure load of the right ventricle (RV). Despite major advances in our understanding of the mechanisms of RV adaptation to the increased pressure, substantial gaps in our knowledge remain unsettled. One of much less known aspect of pressure overload of RV is its impact on electrocardiographic (ECG) changes. In this study, we aimed to study whether acute and chronic RV overload are accompanied by different ECG patterns. Methods: Thirty-eight patients with PE underwent ECG monitoring were compared with 20 matched patients with PS in this observational retrospective study. ECG abnormalities suggestive of RV overload were recorded and analyzed in both groups. Logistic regression analysis was used to define the predictors of chronic RV overload. Results: Among the ECG changes studied, premature atrial contraction (OR-12.2, 95% CI, 1.3-107, p=0.008), right axis deviation (OR-20.4, 95% CI 4.2-98, p<0.001), indeterminate axis (OR-0.11, 95% CI 0.02-0.44, p=0.001 0.11), incomplete right bundle branch block (OR-4.2, 95% CI, 1.1-15.4, p=0.02), late R in aVR (OR-8.4, 95% CI 2.1-33.2, p=0.001), qR in V1 lead (OR-8.3, 95% CI 1.2-74.8, p=0.03) were found to be the independent predictors of chronic RV pressure overload. Conclusion: Our data indicate that the ECG changes that attributed to the acute RV pressure loading states may be more prevalent in chronic RV overload as compared with acute RV overload. (Anadolu Kardiyol Derg 2013; 13: 344-9) Key words: Right ventricular pressure load, electrocardiography, disease process, regression analysis Original Investigation Özgün Araşt›rma 344ÖZET Amaç: Sağ ventrikül (SV) fonksiyonu birçok kardiyopulmoner hastalıklarda klinik sonlanım olarak önemli rol oynar. Pulmoner emboli (PE) ve ciddi pulmoner darlık (PD) SV basınç yüklenmesi ile seyreden iki ayrı hastalıktır. SV' nin artmış basınç yüklenmesine karşı verdiği uyum mekanizmaları iyi bilinmesine karşın hala bazı tanımlanmamış boşluklar devam etmektedir. SV basınç yüklenmesinin elektrokardiyografik (EKG) olarak nasıl bir deği-şiklik yaptığı pek bilinmemektedir. Çalışmamızdaki amaç akut ve kronik basınç yüklenmesini EKG olarak ayrımının yapılabileceğini araştırmaktır. Yöntemler: Bu retrospektif gözlemsel çalışmamıza 20 PD ve 38 PE tanısı kesinleşmiş hasta dahil edildi. SV yüklenmesini gösterdiği daha önceki çalışmalarda kabul edilmiş EKG kriterleri her iki grupta araştırıldı. Logistic regression analysis was used to define the predictors of chronic RV overload. Bulgular: Bakılan EKG değişikliklerinden, prematür atriyal atım (OR-12.2, %95 CI, 1.3-107, p=0.008), sağ aks deviasyonu (95)(96)(97)(98) p=0.001), indetermine aks (OR-0.11, %95 CI 0.02-0.44, p=0.001), inkomplet sağ dal bloğu (OR-4.2, %95 CI, 1.1-15.4, p=0.02), aVR de geç R dalgası (OR-8.3, %95 CI 1.2-74.8, OR-8.4, %95 CI 2.1-33.2 p=0.001), V1' de qR dalgası (OR-8.3, %95 CI 1.2-74.8 p=0.02) SV kronik basınç yüklenmesini gös-teren bağımsız prediktörle...

Akut Pulmoner Embolili Hastalarda R Dalga Pik Zamanının Tanısal Öngörücü Değeri

“…In terms of laboratory parameters, only D-dimer and sodium levels were different between the two groups (p=0.005 and p=0.026, respectively). The median value of the Wells score and revised Geneva score were 3 (3-6) and 5 (3)(4)(5)(6)(7)(8)(9)(10) in patients with APE, respectively. Only the revised Geneva score was statistically different in patients with APE compared to those without APE (p=0.031), the Wells score was similar between the two groups (p>0.05 for all).…”

“…It has been reported that multiple ECG changes might be found in patients with APE. The ECG findings may include atrial arrhythmia, right axis deviation, complete or incomplete right bundle branch block, sinus tachycardia with secondary ST-T changes, S1Q3T3 pattern, T inversions and ST depressions in the right to mid-precordial leads (3,4). However, the ECG changes are not in the desired range of sensitivity and specificity for the diagnosis of APE (5)(6)(7).…”