The aim of the work is to compare vectorcardiographic (VCG) variables - spatial QRS-T angle and electrocardiographic ventricular gradient (VG) with echocardiography (EchoCG) data in patients with idiopathic pulmonary hypertension (IPH) and chronic thromboembolic pulmonary hypertension (CTEPH). Materials and methods. In 40 patients with IPH and 40 patients with CTEPH at the age of 45±12 years, systolic pulmonary artery pressure (SPAP); the sizes of heart chambers, parameters of RV systolic and diastolic function were evaluated with EchoCG. The QRS-T and VG angles were calculated on the VCG, derived from 12-lead digital ECG. Results. In all patients SPAP was greater than 40 mm Hg (mean 83±18 mm Hg), EchoCG data indicated hypertrophy and dilatation of RV, its systolic and diastolic function; dilatation of the right atrium (RA). Prognostically unfavorable changes in EchoCG were observed: the presence of pericardial effusion in 35 (44%) patients, RA area greater than 26 cm2 in 18 (23%) patients; TAPSE less than 1.5 cm in 37 (46%) patients. EchoCG and VCG variables had statistically significant differences in patients with III-IV functional class in comparison with I-II functional class. Statistically significant moderate correlations between VCG and EchoCG variables were revealed. VCG variables allowed to separate patient groups with the presence and absence of prognostically unfavorable changes in EchoCG with sensitivity from 54 to 78% and specificity from 66 to 87%. Conclusion. In patients with IPH and CTEPH, changes of QRS-T angle and VG correlate with SPAP, the size of RV and RA, parameters of RV systolic and diastolic function. The possibility of the use of QRS-T angle and VG for the detection of patients with prognostically unfavorable echocardiographic changes in the general group of patients with IPH and CTEPH has been shown.
Aim. To determine the features of patients with arterial hypertension (AH) with a discrepancy of electrocardiographic, including vectorcardiographic (VCG) and echocardiographic conclusions about the presence of left ventricular hypertrophy (LVH). Materials and methods. 140 patients with AH were examined (mean age 59.8±12.0 years, 33.6% of men). The Sokolov- Lyon criterion, the Cornell product, the sum of the amplitudes of the R wave in lead X and the S wave in lead Z of the synthesized vectorcardiogram (RX+SZ) and the amplitude of the maximal QRS vector (MQRS) were analyzed. Left ventriclular myocardial mass (LVMM) was calculated using the ASE formula, LVMM/height2.7 more than 44 g/m2.7 in women and more than 48 g/m2.7 in men was considered a criterion for LVH.Results. In patients with AH, pathological RX+SZ and MQRS values were significantly more frequent compared with the Sokolov-Lyon criterion and the Cornell product. Pathological values of RX+SZ and MQRS were met both in patients with an increased and with a normal indexed LVMM. Patients with "true-positive" VCG findings compared with "false-negative" had significantly larger values of the relative wall thickness, LVMM and indexed LVMM. Patients with “false positive” VCG findings compared with “true-negative” were more likely to have left ventricular diastolic dysfunction (90% and 68%, respectively). Patients with the presence of VCG criteria for LVH, both with normal and with an increased indexed LVMM, were characterized by higher values of systolic blood pressure and higher values of the QRS duration. Conclusion. In patients with arterial hypertension, pathological values of vectorcardiographic indices were significantly more frequent compared with the Sokolov-Lyon criterion and the Cornell product. VCG indices allowed to separate groups of patients with the presence and absence of diastolic dysfunction of the left ventricle, as well as groups of patients with normal and elevated values of systolic blood pressure.
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