Electrocardiographic detection and monitoring of pulmonary Hypertension

Initial symptoms of pulmonary hypertension (PH) are easily missed, while early diagnosis and treatment is essential. Pulmonary arterial pressure (PAP) assessment by right heart catheterization or echocardiography is not feasible for periodic monitoring of patients at risk of developing PH. Here we investigate the possible use of the electrocardiogram (ECG) as a screening instrument for early PH detection and for monitoring its course. We studied patients in whom at two diferent dates mean PAP measurements were done (either by echocardiography or by right heart catheterization) and in whom two 12-lead ECGs had been made within three months from the dates on which the mean PAP assessments were done. In each of these patients, the change in mean PAP was classified into one of three categories: decrease> 7.5 mmHg, increase> 7.5 mmHg, or limited change (increase/decrease ≤ 7.5 mmHg). The ECG output variable was a projection of the ventricular gradient (VG) optimized for right ventricular pressure overload detection: VG _rvpo , A total of 39 patients (15/24 m alelJem ale, age 60±12 years) was studied. Mean PAP and VGrvpo changed by -15±7 mmHg and -13±26 mV·ms in the mean PAP decrease group, and by 12±4 mmHg and 8±12 m V·ms in the mean PAP increase group, respectively. The VG _rvpo changes in the mean PAP increase and decrease groups difered significantly (P<;0. 05). A total of 39 patients (15/24 m alelJem ale, age 60±12 years) was studied. Mean PAP and VGrvpo changed by -15±7 mmHg and -13±26 mV·ms in the mean PAP decrease group, and by 12±4 mmHg and 8±12 mV·ms in the mean PAP increase group, respectively. The VG _rvpo changes in the mean PAP increase and decrease groups differed significantly (P<;0. 05). These results suggest that the ECG can be used as a monitoring instrument to detect changes in PAP.