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

Abstract

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.

Eisenmenger syndrome – an electrocardiographic and echocardiographic assessment of the right ventricle

“…Another serious problem associated with RV hypertrophy and dysfunction is the presence of arrhythmias. Arrhythmias typically occur in correlation with hemodynamic progression and RV deterioration (33,38,41,42). However, new onset of arrhythmia in a previously stable patient also very frequently leads to signifi cant clinical worsening.…”

“…Electrocardiographic (ECG) evaluation of the RV is nowadays mostly neglected in clinical practice and it has a rather marginal importance. Even though ECG represents a basic, fi rst-line and most easily accessible diagnostic tool, only few parameters describe RV hypertrophy and dysfunction (34,35,36,37,38,39,40).…”

Rhythm disorders and electrocardiographic abnormalities in adult patients with pulmonary arterial hypertension (RCD code: class II)

“…Interestingly, when and analysis was performed in patients with IPAH only, the combination of these two criteria provided very strong evidence for the presence of RVSD (with positive predictive values of 100%) [23].…”

“…Right ventricular systolic dysfunction (RVSD) is a major complication of PH and a main predictor of death in patients with PAH [21,23].…”

“…[23] aimed to asses usefulness of ECG to determine presence of RVSD in patients with PAH and inoperable CTEPH. The cardiac magnetic resonance imaging was used as a reference test for measurement of right ventricular ejection fraction.…”