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

Abstract

Background: Balloon pulmonary angioplasty (BPA) is a treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods and results: In 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.

Conclusion: BPA therapy reduced the pulmonary arterial pressure in patients with CTEPH and was associated with an improvement in the ECG findings related to RVH.

Keywords: Balloon pulmonary angioplasty; Chronic thromboembolic pulmonary hypertension; Electrocardiogram; Right ventricular hypertrophy.

Fig. 1

Receiver-operating characteristics curves for the ECG parameters for predictors of pulmonary hypertension. The area under the curve (AUC), cut-off level, sensitivity, and specificity are shown. *p < 0.01 vs. AUC = 0.5.

Fig. 2

The prevalence of the ECG parameters. The prevalence before and after the BPA are shown, respectively. The asterisk shows the different between that before and after the BPA (p < 0.05).

Fig. 3

Association between the changes in the mean pulmonary artery pressure and changes in the electrocardiogram parameters.

Fig. 4

The 6MWD and WHO FC at 6 months of follow-up significantly differ between the patients with and without an improvement in the R in V1 + S in V5. 6MWD = 6 minute walking distance, WHO FC = WHO functional class.

Supplemental Fig. 1

Association between the changes in the criteria of an R in V1 + S in V5 of ≧10 mm and the changes in the right ventricular diameter. RVD = right ventricular diameter.