Abstract 11925: Comparison of Right Ventricular Outflow Tract-Dominant Hypertrophic Type With Diffuse Type Using Cardiac CT for J Waves and Clinical Parameters in Pulmonary Hypertensive Patients

Abstract

Introduction: J waves are specific in patients with hypothermia, idiopathic ventricular fibrillation, or brain damage. Patients with pulmonary hypertension (PH) may show right ventricular (RV) hypertrophy and fibrosis, leading to abnormal ECG findings. On cardiac CT of PH, two RV hypertrophic (RVH) types are seen, namely RV outflow tract dominant and RV diffuse. Hypothesis: We hypothesize that these two morphological RVH types might have different effects on ECG findings including J waves, and clinical severity in PH patients. Method: We retrospectively analyzed 43 PH patients (33 females, 55±15 yrs, 31 chronic thromboembolic PH, 7 idiopathic pulmonary arterial (PA) hypertension). Cases were divided into 3 groups: RV outflow tract dominant RVH (gp 1) (N=6), RVH diffuse (gp 2) (N=26), and no RVH (gp 3) (N=11). Results: In gp 1, one (17%) had J waves in II, III, and aVF leads with a maximum RV wall thickness on end-diastole 7.5mm. In gp 2, three (12%) had J waves in II, III, and aVF leads with maximum RV wall thickness on end-diastole 6.7, 6.1, and 5.6mm, respectively. In gp 3, none (0%) had J waves. In gp 1, all six (100%) had a negative T wave in V1-3 leads or beyond and in gp 2, 24 (92%) had a negative T wave in V1-3 leads or beyond (P=0.483). There were significant positive correlations between maximum RV wall thickness in end-diastole and plasma brain natriuretic peptide (BNP) in gp 1 (R=0.44) but no correlations in gp 2. There were significant positive correlations between maximum RV wall thickness in end-diastole and estimated PA systolic pressure (PASP) on TTE in gp 1 (R=0.38) but no correlations in gp 2. Conclusions: In 32 PH participants with an organized RV myocardial change, such as RV outflow tract dominant and diffuse type RVH, 17% and 12% had J waves in II, III, and aVF leads and most of them had a negative T wave in V1-3 leads or beyond. Only RV outflow tract dominant RVH showed significant positive correlations between maximum RV wall thickness in end-diastole, plasma BNP and estimated PASP.