Detection and Evaluation of Pulmonary Hypertension by a Synthesized Right-Sided Chest Electrocardiogram

Abstract

Background: Current standard 12-lead electrocardiogram (ECG) criteria for diagnosing pulmonary hypertension (PH) have a low sensitivity. Although the right-sided chest ECG (V3R V5R) increases the diagnostic accuracy, these additional leads are not routinely recorded. The aim of the present study was to assess the usefulness of the synthesized right-sided chest ECG (Syn-ECG), generated from 12-lead ECG information, in the detection and evaluation of PH. Patients and Methods:The Syn-ECG waveforms in 30 patients with PH, defined as an estimated pulmonary arterial systolic pressure (PASP) >35 mmHg, were compared to those in 30 age-and gendermatched normal subjects. Results:The R wave amplitude and R! S ratio in the Syn-ECGs were significantly (P<0.01) greater in patients with PH than in the controls. The R wave amplitude in the Syn-ECGs exhibited a significant and better correlation (correlation coefficient 0.513 0.596, P<0.001) with the PASP than lead V1 (correlation coefficient 0.375, P=0.02). A receiver-operating characteristic curve analysis showed that the R wave amplitude (AUC 0.802, P<0.001) and R! S ratio (AUC 0.823, P<0.001) in the synthesized V5R was a good predictor of PH. New criteria, including 1) an R in V5R>0.12 mV, and 2) R! S ratio in V5R>0.42, had an improved sensitivity (0.63 and 0.73, respectively) and comparable specificity (0.93 and 0.87, respectively) to the conventional criteria (sensitivity 0.10 0.43, specificity 0.90 1.00). Conclusion:The diagnostic criteria derived from the Syn-ECG provided better diagnostic accuracy than the known conventional criteria from the standard 12-lead ECG. This technique described in the present study may be useful for diagnosing and evaluating PH. (J Nippon Med Sch 2015; 82: 136 145)

The evolution of electrocardiographic signs of right ventricular overload after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

“…19 It was also proved that the degree of the right ventricular size reduction was correlated with the change in the cardiac axis and geometry observed on ECG examination. 22,24 Nishiyama et al 12 showed that the treatment of patients with CTEPH with BPA caused the withdrawal of patients with CTEPH who underwent percutaneous treatment and resolution of specific ECG variables of the RVH.…”

“…[18][19][20] It was shown that the presence of the qR complex in lead V 1 , R/S ratio in lead V 1 , and P -wave amplitude in lead II had significant prognostic value in the population of patients with pulmonary hypertension, and some of them might be used to assess the efficacy of the therapy applied. 18,[21][22][23] It has been proved that the said presence of qR complex in lead V 1 reflects the midsystolic dilation and flattening of the right ventricle very well and is an important predictor of mortality in the population of patients with pulmonary hypertension. 23 Therefore, the presence of qR complex was used in our analysis.…”

Improvement in the electrocardiograms associated with right ventricular hypertrophy after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

“…A size reduction of the RV may correlate with the changes in the rotation and axis. Horizontal plane loop vectorcardiography in RVH exhibits a rightward and anterior deviation [ 26 , 27 ]. It was considered that the BPA therapy improved the deviation of the horizontal loop.…”

Prevalence of pulmonary artery hypertension in patients of chronic obstructive pulmonary disease and its correlation with stages of chronic obstructive pulmonary disease, exercising capacity, and quality of life

“…stated that the R wave amplitude and R/S ratio in the Syn-ECGs were significantly greater in patients with PH than in the controls ( P < 0.01) while the R wave amplitude in the Syn-ECGs exhibited a significant and better correlation with the PASP than lead V1. [ 6 ] There was statistically significant dilated PA or RA/RV enlargement in 81.8% of moderate and 100% of severe PH ( P < 0.001). Patients of severe PH and Stage D COPD were failed to perform 6MWT.…”