Abstract
Electrocardiogram (ECG) has been widely used for assessment of right ventricular (RV) hypertrophy (RVH) in patients with pulmonary hypertension (PH). However, it still remains unclear which ECG criteria of RVH are useful to predict for the severity of PH. The aim of our study was to examine the utility of ECG findings of RVH in assessment of PH. A total of 53 patients (42 women, mean age; 57.6 ± 16.4 years) with pre-capillary PH, who were diagnosed by right heart catheterization, underwent blood sampling, ECG, and cardiac magnetic resonance within a week before the right heart catheterization. We assessed the traditional ECG criteria of RVH in PH patients, and compared to age- and gender-matched control subjects without PH confirmed by 2-dimensional echocardiography (n = 42, mean age 55.3 ± 15.9 years). We also analyzed the clinical variables associated with ECG findings in patients with PH. Mean pulmonary arterial pressure (mPAP), cardiac index, and pulmonary vascular resistance (PVR) in PH patients were 35.3 ± 11.9 mmHg, 2.82 (2.09–3.45) L/min/m2, and 576 ± 376 dyne·sec·cm-5, respectively. The prevalence of right axis deviation (43.4%), R:S ratio V1 > 1 (32.1%), and RV1+SV5/6 > 10.5 mm (69.8%) in PH patients was greater than those in control subjects (p < 0.001). In univariate analysis, mPAP, PVR, RV wall thickness, RV mass index, RV volume, and RV ejection fraction (EF) (inversely) were significantly correlated with the amplitude of RV1+SV5/6. Multiple regression analysis revealed that mPAP and RVEF (inversely) were independently associated with the amplitude of RV1+SV5/6 (R2 = 0.282). Also, we performed the survival analysis among pre-capillary PH patients. During a mean follow-up of 3.7 years, patients with ≥ 16.4 mm of RV1+SV5/6 had worse prognosis than those with < 16.4 mm (Log rank p = 0.015). In conclusion, the amplitude of SV1+RV5/6 could be the most useful factor reflected for RV remodeling, hemodynamics and survival in patients with pre-capillary PH.
Highlights
Pre-capillary pulmonary hypertension (PH) is a progressive disease characterized by increased pulmonary vascular resistance (PVR), which causes right ventricular (RV) remodeling such as hypertrophy and/or enlargement [1, 2], resulting in right heart failure and death [3, 4]
A 10-year follow-up study in patients with pre-capillary PH demonstrated that patients with mean PAP 42.5 mmHg showed worse survival rates than those with mPAP < 42.5mmHg [5], patients with pre-capillary PH can present the different courses of RV remodeling according to the disease severity; one is adaptive remodeling, and the other is maladaptive
Thirty-five (66.0%) with pulmonary arterial hypertension (PAH), 12 (22.6%) with PAH coexisting pulmonary disease, and 5 (9.4%) with CTEPH patients were enrolled in the present study
Summary
Pre-capillary pulmonary hypertension (PH) is a progressive disease characterized by increased pulmonary vascular resistance (PVR), which causes right ventricular (RV) remodeling such as hypertrophy and/or enlargement [1, 2], resulting in right heart failure and death [3, 4]. Accurate assessment of RV remodeling is important to evaluate the disease severity in patients with pre-capillary PH. RV hypertrophy (RVH) is initially an adaptive physiological response to increased overload. Adaptive remodeling is characterized by the increased RV wall thickness/ mass and the preserved RV function, whereas maladaptation is related to the enlarged RV and the reduced RV function [6]. Echocardiography and cardiovascular magnetic resonance (CMR) imaging are established for assessment of the RVH and RV function [10, 11], a low-cost equipment is required
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