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

Abstract

BackgroundBalloon pulmonary angioplasty (BPA) is a treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH).Methods and resultsIn 60 patients with CTEPH, we examined the hemodynamic data before and after BPA. In addition, the sequential ECG findings for right ventricular hypertrophy (RVH) were assessed. The mean pulmonary arterial pressure (mPAP) decreased from 38 ± 11 to 20 ± 4 mm Hg (p < 0.05). The ROC analysis showed that the S waves in V5, R waves in V1 + S waves in V5, S waves in I, and QRS axis were significant predictors of an mPAP ≧ 30 mm Hg (AUC > 0.75, p < 0.01). The predictive values for the mPAP before the BPA were the S and R waves in lead V6, and P waves in lead II (33.417 + 0.078 × P in II − 0.10 × R in V6 + 0.012 × S in V6). The change in the mPAP (ΔmPAP) correlated with the change in the amplitudes of the ECGs: ΔS wave in lead I (R = 0.544, p < 0.001), ΔR in V1 + S in V5 (R = 0.476, p < 0.001), and ΔP wave in II (R = 0.511, p < 0.001). At 6 months of follow-up, the improvement in an R in V1 + S in V5 of ≧10 mm implied a better functional status.ConclusionBPA therapy reduced the pulmonary arterial pressure in patients with CTEPH and was associated with an improvement in the ECG findings related to RVH.

Assessment of electrocardiographic markers of acute and long‐term hemodynamic improvement in patients with pulmonary hypertension

“…Our study demonstrated significant changes in R‐ and S‐wave amplitude in V 5 and V 6 values but only in the model of long‐term hemodynamic improvement, as in previous studies on significant hemodynamic improvement in CTEPH patients who received interventional therapy (Nishiyama et al, 2018; Pilka et al, 2019). The value of the T‐wave axis in relation to the long‐term hemodynamic improvement model in the current study was the same as in a recent publication by us (Pilka et al, 2019).…”

“…For the QRS complex, the value of the change in the axis was confirmed in patients with CTEPH after the application of hemodynamically effective interventional therapy (Nishiyama et al, 2018). Similarly, the duration of the QRS complex concerning the prognosis was well‐documented in the CTEPH patients (Asano et al, 2019).…”

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

“…Moreover, a correlation was found with regard to the observed changes in the mPAP and in the values of the following ECG parameters: S wave in lead I, sum of amplitude of R wave in lead V 1 and S wave in lead V 5 , as well as P -wave amplitude in lead II. 12 The above study also showed that the R/S ratio in lead V 1 of 1 or higher might be observed with a higher frequency in patients with CTEPH whose hemodynamic parameters were improved following treatment with BPA. 12 Our study also confirmed the clinical significance of the amplitude of R and S waves in lead V 5 in the assessment of reverse ECG right ventricular remodeling.…”

“…12 The above study also showed that the R/S ratio in lead V 1 of 1 or higher might be observed with a higher frequency in patients with CTEPH whose hemodynamic parameters were improved following treatment with BPA. 12 Our study also confirmed the clinical significance of the amplitude of R and S waves in lead V 5 in the assessment of reverse ECG right ventricular remodeling. Concerning P wave, its assessment was significant not only in lead II but also in lead III.…”

“…Both previous studies and the present study confirmed the significance of the S wave in lead I, whose amplitude change in our study was correlated with the change in the PVR and mPAP. 12,19 In patients with CTEPH, RBBB associated with RVH is usually related to right ventricle enlargement and a lengthening of the conduction pathway. It should be kept in mind that the size of the right ventricle cavity may be subject to certain dynamics.…”