Electrocardiographic Differences Between COPD Patients Evaluated for Lung Transplantation with and Without Pulmonary Hypertension

Overview

Journal COPD

Publisher Informa Healthcare

Specialty Pulmonary Medicine

Date 2014 Jul 2

PMID 24983839

Citations 5

Authors

Laith Alkukhun

Manfred Baumgartner

Marie Budev

Raed A Dweik

Adriano R Tonelli

Affiliations

Soon will be listed here.

Abstract

Introduction: Pulmonary hypertension (PH) is an indicator of poor prognosis in COPD patients; particularly in those with mean pulmonary artery pressure ≥ 40 mm Hg. Electrocardiography (ECG) might be useful for screening of this condition.

Methods: Retrospective study of COPD patients evaluated for lung transplantation in whom we analyzed the 12-lead ECG performed closest to the time of right heart catheterization.

Results: We included 142 patients. PH was present in 90 patients (63%) and 16 (11%) had a mean PAP ≥ 40 mmHg. The PR interval was longer in PH patients (151 (29) versus 139 (22) ms, p = 0.01) and T wave axis had a left shift (56.9 (32) versus 68.7 (19) degrees, p = 0.006). PR interval was longer (178.5 (35) versus 142.2 (23) ms, p = 0.001), T wave axis had a leftward deflection (63.6 (24) versus 42.8 (46) degrees, p = 0.005) and S wave in lead I was larger (0.19 (0.13) versus 0.12 (0.12) mV, p = 0.03) in patients with mean PAP ≥ 40 mmHg. A PR interval > 137 ms and S wave in DI > 0.02 mV had a sensitivity of 100% and a specificity of 59.5% to identify COPD patients with a mean PAP ≥ 40 mmHg.

Conclusion: There are significant ECG differences between advanced COPD patients with and without PH; however the ECG is an inadequate tool to differentiate between the groups. A prolonged PR interval suggests the presence of severe PH.

Citing Articles

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References

Pfeufer A, van Noord C, Marciante K, Arking D, Larson M, Smith A . Genome-wide association study of PR interval. Nat Genet. 2010; 42(2):153-9. PMC: 2850197. DOI: 10.1038/ng.517. View

Spodick D . Electrocardiographic studies in pulmonary disease. II. Establishment of criteria for the electrocardiographic inference of diffuse lung diseases. Circulation. 1959; 20:1073-4. DOI: 10.1161/01.cir.20.6.1073. View

Andersen C, Mellemkjaer S, Nielsen-Kudsk J, Sonderskov L, Laursen B, Simonsen U . Echocardiographic screening for pulmonary hypertension in stable COPD out-patients and NT-proBNP as a rule-out test. COPD. 2012; 9(5):505-12. DOI: 10.3109/15412555.2012.695818. View

Scott R . The electrocardiogram in pulmonary emphysema and chronic cor pulmonale. Am Heart J. 1961; 61:843-5. DOI: 10.1016/0002-8703(61)90472-0. View

Cuttica M, Kalhan R, Shlobin O, Ahmad S, Gladwin M, Machado R . Categorization and impact of pulmonary hypertension in patients with advanced COPD. Respir Med. 2010; 104(12):1877-82. DOI: 10.1016/j.rmed.2010.05.009. View

Phillips R . The electrocardiogram in cor puimonale secondary to pulmonary emphysema: a study of 18 cases proved by autopsy. Am Heart J. 1958; 56(3):352-71. DOI: 10.1016/0002-8703(58)90275-8. View

ROMAN Jr G, Walsh T, MASSIE E . Right ventrical hypertrophy. Correlation of electrocardiographic and anatomic findings. Am J Cardiol. 1961; 7:481-7. DOI: 10.1016/0002-9149(61)90504-5. View

Warnier M, Rutten F, Numans M, Kors J, Tan H, de Boer A . Electrocardiographic characteristics of patients with chronic obstructive pulmonary disease. COPD. 2013; 10(1):62-71. DOI: 10.3109/15412555.2012.727918. View

Halbert R, Isonaka S, George D, Iqbal A . Interpreting COPD prevalence estimates: what is the true burden of disease?. Chest. 2003; 123(5):1684-92. DOI: 10.1378/chest.123.5.1684. View

10.

SELVESTER R, Rubin H . NEW CRITERIA FOR THE ELECTROCARDIOGRAPHIC DIAGNOSIS OF EMPHYSEMA AND COR PULMONALE. Am Heart J. 1965; 69:437-47. DOI: 10.1016/0002-8703(65)90413-8. View

11.

Ranieri V, Rubenfeld G, Thompson B, Ferguson N, Caldwell E, Fan E . Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012; 307(23):2526-33. DOI: 10.1001/jama.2012.5669. View

12.

Dolan S, Varkey B . Prognostic factors in chronic obstructive pulmonary disease. Curr Opin Pulm Med. 2005; 11(2):149-52. DOI: 10.1097/01.mcp.0000153548.36054.8f. View

13.

Zhao Y, Liu Y, Stan R, Fan L, Gu Y, Dalton N . Defects in caveolin-1 cause dilated cardiomyopathy and pulmonary hypertension in knockout mice. Proc Natl Acad Sci U S A. 2002; 99(17):11375-80. PMC: 123264. DOI: 10.1073/pnas.172360799. View

14.

Badesch D, Champion H, Gomez Sanchez M, Hoeper M, Loyd J, Manes A . Diagnosis and assessment of pulmonary arterial hypertension. J Am Coll Cardiol. 2009; 54(1 Suppl):S55-S66. DOI: 10.1016/j.jacc.2009.04.011. View

15.

Fisher M, Forfia P, Chamera E, Housten-Harris T, Champion H, Girgis R . Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary hypertension. Am J Respir Crit Care Med. 2009; 179(7):615-21. PMC: 2720125. DOI: 10.1164/rccm.200811-1691OC. View

16.

Mannino D, Buist A . Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007; 370(9589):765-73. DOI: 10.1016/S0140-6736(07)61380-4. View

17.

Kessler R, Faller M, Fourgaut G, Mennecier B, Weitzenblum E . Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999; 159(1):158-64. DOI: 10.1164/ajrccm.159.1.9803117. View

18.

Prakash R . Echocardiographic diagnosis of right ventricular hypertrophy: correlation with ECG and necropsy findings in 248 patients. Cathet Cardiovasc Diagn. 1981; 7(2):179-84. DOI: 10.1002/ccd.1810070207. View

19.

Oswald-Mammosser M, Weitzenblum E, Quoix E, Moser G, Chaouat A, Charpentier C . Prognostic factors in COPD patients receiving long-term oxygen therapy. Importance of pulmonary artery pressure. Chest. 1995; 107(5):1193-8. DOI: 10.1378/chest.107.5.1193. View

20.

Shujaat A, Bajwa A, Cury J . Pulmonary Hypertension Secondary to COPD. Pulm Med. 2012; 2012:203952. PMC: 3437672. DOI: 10.1155/2012/203952. View