Prognostic Value of Cardiac Axis Deviation in Systemic Sclerosis–Related Pulmonary Hypertension

Abstract

Objective Systemic sclerosis–related pulmonary hypertension (SSc‐PH) is a common complication of SSc associated with accelerated mortality. The present study was undertaken to investigate whether cardiac axis deviation indicates abnormalities in cardiac function allowing for prognostication of disease severity and mortality. Methods This was a retrospective study in which electrocardiograms (ECGs) were reviewed for cardiac axis deviation and their association with echocardiography and cardiopulmonary hemodynamics on right‐sided heart catheterization. The primary outcome observed was all‐cause mortality from the time of PH diagnosis. Results ECG results were reviewed from 169 patients with SSc‐PH. Right axis deviation (RAD) and left axis deviation (LAD) occurred in 28.4% and 30.8% of patients with SSc‐PH, respectively. Compared to those without RAD, patients with RAD exhibited predominantly right‐sided cardiac disease on echocardiography and increased PH severity by cardiopulmonary hemodynamics including a greater mean ± SD pulmonary artery pressure (42.0 ± 12.5 mm Hg versus 29.8 ± 7.0 mm Hg) and mean ± SD pulmonary vascular resistance (645.6 ± 443.2 dynes · seconds/cm5 versus 286.3 ± 167.7 dynes · seconds/cm5). LAD was associated with predominantly left‐sided cardiac disease on echocardiography but was not associated with PH severity on cardiopulmonary hemodynamics. Both RAD (hazard ratio 10.36 [95% confidence interval 4.90–21.93], P < 0.001) and LAD (hazard ratio 2.94 [95% confidence interval 1.53–5.68], P = 0.001) were associated with an increased hazard for all‐cause mortality. Conclusion RAD and LAD reflect structural cardiac abnormalities and are associated with poor prognosis in patients with SSc‐PH. These findings support the importance of electrocardiography, an inexpensive, widely available noninvasive test, in risk stratification.

A Multimodal Prediction Model for Diagnosing Pulmonary Hypertension in Systemic Sclerosis

“…Furthermore, when the FVC/D L CO ratio was used in the random forest model instead of individual measurements of FVC and D L CO, the model performed poorly, likely related to the decrease in degrees of freedom of the model by collapsing 2 variables into 1 variable. Although ECG has been observed to be a prognostic indicator of all‐cause mortality in patients with SSc‐PH (13), it was not an important predictor of PH in the present study. The finding of an insignificant tricuspid regurgitant jet velocity in close to one‐quarter of patients is notable and consistent with previous findings (6).…”

“…We incorporated the following as variables in the prediction models: 1) PFT variables including forced vital capacity (FVC) and D L CO (as individual variables and separately as FVC/D L CO ratio); 2) ECG variables including left axis deviation (LAD), right axis deviation (RAD), and right bundle branch block (RBBB) (13); 3) echocardiography variables including aortic regurgitation, mitral regurgitation, tricuspid regurgitation, pulmonic regurgitation, left ventricular ejection fraction (LVEF), left ventricular diastolic dysfunction, left ventricular hypertrophy, left atrial (LA) dilation, right atrial (RA) dilation, right ventricular (RV) dilation, RV dysfunction, and pericardial effusion; and 4) pulmonary artery (PA) diameter on CT chest imaging, measured at the level of the bifurcation of the main PA in the axial plane (14).…”

Arrhythmias and Conduction Disturbances in Patients with Systemic Sclerosis—A Systematic Literature Review

“…If any conflicts emerged during the review process, they were resolved by discussion among the readers. Sixty articles were finally included in this systematic literature review [ 8 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ...…”

Electrocardiogram properties and risk of covert brain infarction and other magnetic resonance imaging abnormalities in a stroke‐free population

“…Thus, activation of the basal anterolateral region may be delayed (Abu‐Alrub et al., 2021). Second, left axis deviation was related to left‐sided structural abnormalities, specifically LV diastolic and systolic dysfunction, as well as LV dilation (Lui et al., 2021). These two reasons may cause a decrease in the flow velocity in the left ventricle and cerebral blood flow, thereby contributing to stasis and ischemia of small‐vessel territories and brain infarcts (Cannistraro et al., 2019; Di Tullio et al., 1999; Nakanishi et al., 2017; Wardlaw et al., 2013; Yaghi et al., 2018).…”