Connection between right ventricular pressure and the ECG

Medvegy, Mihály; Antalóczy, Z; Préda, István

doi:10.1016/s0022-0736(05)80106-2

Cited by 7 publications

(3 citation statements)

References 9 publications

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“…In our study, the assessment for right heart strain takes into account the varying sensitivities and specificities of all the ECG criteria used. [12][13][14] Despite this, the study by Halperin et al 10 had a sensitivity of only 50% for ECG evidence of right heart strain in patients with clinical manifestations of CMS. This suggests that, despite postmortem evidence of right heart strain in CMS victims, either the ECG tracings were not sensitive enough or other physiologic factors play a role in clinical CMS.…”

Section: Study Limitationsmentioning

confidence: 99%

Electrocardiographic Evidence for Right Heart Strain in Asymptomatic Children Living in Tibet—A Comparative Study Between Han Chinese and Ethnic Tibetans

Hulme

Ingram

Lonsdale-Eccles³

2003

Wilderness & Environmental Medicine

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Section: Study Limitationsmentioning

confidence: 99%

Electrocardiographic Evidence for Right Heart Strain in Asymptomatic Children Living in Tibet—A Comparative Study Between Han Chinese and Ethnic Tibetans

Hulme

Ingram

Lonsdale-Eccles³

2003

Wilderness & Environmental Medicine

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“…For this reason, electrocardiographic signs are usually rare in mild PH and may be absent altogether [ 33 , 39 , 43 , 44 ]. Thus, an ECG can provide clear evidence of PH, especially in severe PH, but the absence of ECG signs does not exclude PH [ 19 , 27 , 32 , 45 , 46 , 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Analysis of Electrocardiographic Criteria of Right Ventricular Hypertrophy in Patients with Chronic Thromboembolic Pulmonary Hypertension before and after Balloon Pulmonary Angioplasty

Ley

Wiedenroth

Ghofrani

et al. 2023

JCM

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Background: Chronic thromboembolic pulmonary hypertension (CTEPH) may lead to typical electrocardiographic changes that can be reversed by balloon pulmonary angioplasty (BPA). The aim of this study was to investigate the significance of rarely used electrocardiogram (ECG) parameters, possible electrocardiographic differences between residual and significantly improved CTEPH and the role of electrocardiographic parameters in low mPAP (mean pulmonary arterial pressure) ranges since the mPAP threshold for the definition of pulmonary hypertension has recently been adjusted (≥25 mmHg to >20 mmHg). Material and Methods: Between March 2014 and October 2020, 140 patients with CTEPH and 10 with CTEPD (chronic thromboembolic pulmonary disease) without pulmonary hypertension (PH) were retrospectively enrolled (12-lead ECG and right heart catheterization before and 6 months after BPA). The ECG parameters of right heart strain validated by studies and clinical experience were evaluated. Special attention was paid to six specific ECG parameters. After BPA, the cohort was divided into subgroups to investigate possible electrocardiographic differences with regard to the haemodynamic result. Results: The present study confirmed that the typical electrocardiographic signs of CTEPH can be found on an ECG, can regress after BPA and partially correlate well with haemodynamic parameters. “R V1, V2 + S I, aVL − S V1” was a parameter of particular note. BPA reduced its frequency (47% vs. 29%) statistically significantly after Bonferroni correction (p < 0.001). Moreover, it showed a good correlation with mPAP and PVR (r-values: 0.372–0.519, p-values: < 0.001). Exceeding its cut-off value before therapy was associated with more severe CTEPH before therapy (higher mPAP, PVR, NT-pro-BNP and troponin and lower TAPSE) and an increased risk of death. Exceeding its cut-off value before and after therapy was associated with more severe CTEPH after therapy (higher RAP, mPAP, PVR, NT-pro-BNP and NYHA class) and an increased risk of death. Men tend to be affected more frequently. After subgrouping, it was observed that a higher median mPAP was associated with a higher right atrial pressure (RAP), a higher pulmonary vascular resistance (PVR) and a lower cardiac output (CO) before and after BPA. In addition, under these conditions, more and more severe electrocardiographic pathologies were detected before and after BPA. Some patients with low mPAP also continued to show mild ECG changes after BPA. In some cases, very few to no pathological ECG changes were detected, and the ECG could present as mostly normal in some patients (5% before BPA and 13% after BPA). Conclusion: “R V1, V2 + S I, aVL − S V1” seems to be able to support the diagnosis of CTEPH, indicate therapeutic improvement and estimate haemodynamics. It also seems capable of predicting a (persistent) severe disease with probably increased need for therapy and increased mortality. Mild PH has been observed to have either no or few mild ECG changes. This might complicate the (early) detection of PH.

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“…Chronic RV pressure overload affects the terminal depolarization of the QRS vector, the S wave. 23) Thus, the S wave in lead V5 may be more sensitive for detecting PH than the other ECG parameters.…”

Section: )mentioning

confidence: 99%

Deeper S Wave in Lead V5 and Broader Extent of T Wave Inversions in the Precordial Leads are Clinically Useful Electrocardiographic Parameters for Predicting Pulmonary Hypertension

et al. 2018

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SummaryElectrocardiography (ECG) is used to screen for pulmonary hypertension (PH). However, it is unclear which parameters of ECG are the most useful for screening.ECG parameters related to right ventricular hypertrophy criteria were examined in 145 ECGs of subjects who were suspected to have PH and underwent right heart catheterization (RHC) (age 58.4 ± 17.5 years, 112 women, mean pulmonary arterial pressure [MPAP] 35.4 ± 13.3 mmHg). Based on the results of RHC, 108 subjects had PH (56 pulmonary arterial hypertension [PAH] and 52 chronic thromboembolic pulmonary hypertension [CTEPH]).Fourteen of 17 ECG parameters in the present study were significantly associated with PH on univariate analysis. On multivariable logistic regression analysis, S wave depth in lead V5 (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.10-1.47) and depth of T wave inversion in lead V4 (OR 1.21, 95% CI 1.03-1.46) were independent predictors of MPAP !25 mmHg, and the cut-off values determined by receiver operating characteristic curve analyses were 0.42 mV and -0.28 mV, respectively.In conclusion, a deeper S wave in lead V5 and the presence of a wider extent of negative T waves in the precordial leads may be clinically simple and useful ECG parameters for screening for PH.(Int Heart J 2018; 59: 136-142) Key words: Pulmonary arterial hypertension, Chronic thromboembolic pulmonary hypertension P ulmonary hypertension (PH) causes pressure overload of the right ventricle (RV) with RV hypertrophy and dilatation, leading to right heart failure and premature death. Despite recent advances in management, the prognosis of PH patients is still poor, with a 3-year survival rate of 67%.

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Connection between right ventricular pressure and the ECG

Cited by 7 publications

References 9 publications

Electrocardiographic Evidence for Right Heart Strain in Asymptomatic Children Living in Tibet—A Comparative Study Between Han Chinese and Ethnic Tibetans

Electrocardiographic Evidence for Right Heart Strain in Asymptomatic Children Living in Tibet—A Comparative Study Between Han Chinese and Ethnic Tibetans

Analysis of Electrocardiographic Criteria of Right Ventricular Hypertrophy in Patients with Chronic Thromboembolic Pulmonary Hypertension before and after Balloon Pulmonary Angioplasty

Deeper S Wave in Lead V5 and Broader Extent of T Wave Inversions in the Precordial Leads are Clinically Useful Electrocardiographic Parameters for Predicting Pulmonary Hypertension

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