Mechanisms of ECG signs in chronic obstructive pulmonary disease

Abstract

ObjectivePatients with chronic obstructive pulmonary disease (COPD) often have abnormal ECGs. Our aim was to separate the effects on ECG by airway obstruction, emphysema and right ventricular (RV) afterload in patients with COPD.MethodsA cross-sectional study was performed on 101 patients with COPD without left heart disease and 32 healthy age-matched controls. Body mass index (BMI) was measured, and pulmonary function tests, ECG, echocardiography and right heart catheterisation (only patients) were performed. Variables were grouped into (1) airway obstruction by FEV% (percentage of forced expiratory volume)_predicted, (2) emphysema by residual volume/total lung capacity and residual volume (percent of predicted) and (3) RV afterload by mean pulmonary pressure, artery compliance, vascular resistance and RV wall thickness.ResultsIn multivariate regression analysis, emphysema correlated negatively to R+S amplitudes in horizontal and frontal leads, RV/left ventricle (LV) end-diastolic volume ratio to horizontal amplitudes and BMI negatively to frontal amplitudes. Increased airway obstruction, RV afterload and BMI correlated with horizontal QRS-axis clockwise rotation. Airway obstruction, RV afterload, RV/LV end-diastolic volume ratio and BMI correlated to the Sokolow-Lyon Index for RV, and RV afterload negatively to Sokolow-LyonIndex for LV. Several classical ECG changes could, however, not be ascribed to specific mechanisms.ConclusionsIn COPD, the various pathophysiological mechanisms modify the ECG differently. Increased airway obstruction and RV afterload mainly increase the Sokolow-Lyon Index for RV mass and associate with clockwise rotation of the horizontal QRS-axis, whereas emphysema reduces the QRS amplitudes. BMI is an equally important determinant for the majority of the ECG changes.

Changes on Electrocardiographic Patterns and Associated Factors among Chronic Obstructive Pulmonary Disease Patients

“…This is also in agrrementwith study conducted by Larssen MS et al who revealed that being male was risk for developing abnormal ECG with [AOR 1.864(0.39-3.57)]. 26 5. COPD patients with low monthly income less than 2000 ETB are also the risk factor for abnormal ECG among COPD patients by [AOR 2.1(1.6-7.9)] but it was not determined among other reviewed studies.…”

“…The ECG changes observed among heart of COPD patients are high amplitude of P wave, vertical P wave axis, vertical QRS axis, prolonged PR and QT interval as cardiac markers of CVDs suggesting abnormal ECG (arrhythmia, axis deviation, heart chamber enlargement and hypertrophy). 26 Even though, mechanism of COPD induced development of CVDs evidenced with abnormal ECG is complex and unclear; their correlation was expected via the effect of abnormal systemic inflammatory response 27,28 resulting in progression of pathologic atherosclerosis, biological (hypoxemia, endothelial dysfunction, increased platelet activation, arterial stiffness) with the mutual classical risk factors 1 (smoking, pollution, free radicals and aging) that ends in pulmonary vascular dysfunction, pulmonary hy-pertension, right and left heart dysfunction and arrhythmia. The anatomical and physiological similarity of two vital organs also affect each other 29 and may be adverse effects of drugs used to treat COPD can directly induce cardiac problems with acute exacerbation of COPD.…”

“…The identified factors for ECG changes were amount of systemic C-reactive proteins (CRP) as markers of inflammation, hypoxia, duration and severity of COPD which was exacerbated by mutual risk factors smoking and aging. [26][27][28][29][30][31][32][33] Thus, the current study aimed to explore and detect changes of ECG pattern by using the 12 lead ECG which is not routinely performed especially in developing countries including Ethiopia and the study area due to economic constraints and determine the associated risk factors among COPD patients.…”

Electrocardiographic Abnormalities in the Elderly: A Study in a Large Database of Primary Care Patients

“…Previous myocardial infarction was included in the model, and, as expected, it was significantly associated with abnormal ECG. COPD may be associated with ECG abnormalities [29]. However, the prevalence of self-reported COPD was low, so it may be an underdiagnosed condition in this population.…”

P-wave axis as a predictor of mortality

“…Right P-wave axis deviation has been strongly linked to emphysema, a disease that leads to abnormal lung hyperinflation, frequently causing a vertical frontal P-wave axis exceeding 60 degrees. [11][12][13] This association might be due to the right atrium being firmly attached to the diaphragm by way of a pericardial ligament around the inferior vena cava, and with progressive flattening of the diaphragm, the right atrium will be displaced. 14 The authors state that 10% of those with normal P-wave axis versus 11% of those with abnormal P-wave axis had a diagnosis of chronic obstructive pulmonary disease (COPD) at baseline (P ¼ 0.076).…”