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. 2020 Sep;25(5):e12758.
doi: 10.1111/anec.12758. Epub 2020 Apr 26.

Assessment of electrocardiographic markers of acute and long-term hemodynamic improvement in patients with pulmonary hypertension

Michał Piłka  1 , Szymon Darocha  1 , Marta Banaszkiewicz  1 , Maria Wieteska-Miłek  1 , Małgorzata Mańczak  2 , Rafał Mańczak  1 , Piotr Kędzierski  1 , Michał Florczyk  1 , Anna Dobosiewicz  1 , Adam Torbicki  1 , Marcin Kurzyna  1
Affiliations

Assessment of electrocardiographic markers of acute and long-term hemodynamic improvement in patients with pulmonary hypertension

Michał Piłka et al. Ann Noninvasive Electrocardiol. 2020 Sep.

Abstract

Background: The remodeling of the right heart in patients with chronic pulmonary hypertension (cPH) is associated with the appearance of electrocardiographic (ECG) abnormalities. We investigated the resolution of ECG markers of right ventricular hypertrophy (RVH) caused by acute and long-term hemodynamic improvement.

Methods: Twenty-nine (29) patients with chronic thromboembolic pulmonary hypertension (CTEPH) and seven patients with pulmonary arterial hypertension (PAH) were included in the analysis. Patients with CTEPH achieved a significant long-term hemodynamic improvement following the treatment with balloon pulmonary angioplasty (BPA); all the patients with PAH reported significant acute hemodynamic relief after a single inhalation of iloprost, fulfilling the criteria of responder. Standard 12-lead ECG was performed before and after intervention.

Results: The interval between baseline and control ECG in CTEPH and PAH groups was 28 (IQR: 17-36) months and 15 min (IQR: 11-17), respectively. Despite similar hemodynamic improvement in both groups, only the CTEPH group presented significant changes in most analyzed ECG parameters: T-wave axis (p = .002), QRS-wave axis (p = .012), P-wave amplitude (p < .001) and duration in II (p = .049), R-wave amplitude in V1 (p = .017), R:S ratio in V1 (p = .046), S-wave amplitude in V5 (p = .004), R-wave amplitude in V5 (p = .044), R:S ratio in V5 (p = .004), S-wave amplitude in V6 (p = .026), R-wave amplitude in V6 (p = .01), and R-wave amplitude in aVR (p = .031). In patients with PAH, significant differences were found only for P wave in II (duration: p = .035; amplitude: p = .043) and QRS axis (p = .018).

Conclusions: The effective treatment of cPH ensures improvement in ECG parameters of RVH, but it requires extended time.

Keywords: balloon pulmonary angioplasty; chronic thromboembolic pulmonary hypertension; electrocardiography; pulmonary hypertension; responders.

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Conflict of interest statement

Michał Piłka and Michał Florczyk have each received personal fees from Actelion, MSD, and AOP Orphan. Szymon Darocha and Adam Torbicki have each received grants and personal fees from Actelion, MSD, Bayer, and AOP Orphan. Marcin Kurzyna has received grants and personal fees from Actelion, MSD, Bayer, Biotronik and AOP Orphan. The following authors report no conflicts of interest: Marta Banaszkiewicz, Małgorzata Mańczak, Rafał Mańczak, Piotr Kędzierski, and Anna Dobosiewicz.

Figures

FIGURE 1
FIGURE 1
Electrocardiogram (a) before and after iloprost inhalation, (b) before and after three sessions of balloon pulmonary angioplasty
FIGURE 2
FIGURE 2
Comparison of electrocardiographic parameters in the individual groups of patients before and after the application of the appropriate specific therapy (BPA for CTEPH/iloprost inhalation for PAH)
FIGURE 3
FIGURE 3
Selected correlations in percentage change in the values of the electrocardiographic and hemodynamic parameters in patients with chronic hemodynamic improvement (CTEPH)
See this image and copyright information in PMC

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