Pulmonary Vascular Disease |

Electrocardiographic Findings Before Death in Pulmonary Hypertension FREE TO VIEW

Manfred Baumgartner*, MD; Omar Minai, MD; Jennie Newman, BA; Raed Dweik, MD; Adriano Tonelli, MD
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Cleveland Clinic Foundation, Cleveland, OH

Chest. 2012;142(4_MeetingAbstracts):837A. doi:10.1378/chest.1388102
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SESSION TYPE: DVT/PE/Pulmonary Hypertension Posters II

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Controversy exists regarding the appropriate role of electrocardiography (ECG) in pulmonary arterial hypertension (PAH). Little information exits regarding ECG characteristics in PAH patients before their death and progression from initial ECG.

METHODS: We compared ECG findings at the time of presentation to our institution and before death in consecutive patients with PAH that died between June 2008 and December 2010. All patients had PAH confirmed by right heart catheterization.

RESULTS: We included 50 patients with PAH (76 % women) with mean (SD) age of 58 (14) years. PAH was the direct cause of death in 21 (42 %), contributed to death in 23 (46 %) and had no relation in 6 (12 %) patients. Last ECG was performed with a median (interquartile range (IQR)) of 0 (0-2) months before death. Time difference between initial and last ECG was 39 (10-77) months. Median heart rate (83 vs 89 bpm, p=0.001), PR interval (167 vs 176 ms, p=0.03), QRS duration (88 vs 90 ms, p=0.02), R/S ratio in lead V1 (1 vs 2, p=0.01), and QTc duration (431 vs 444 ms, p=0.02) significantly increased from the initial to the last ECG. Before death, the frontal QRS axis rotated to the right (97 vs 112 degrees, p=0.003) and we more commonly observed RBBB (5 vs 8 %, p=0.03) and negative T waves in inferior leads (31 vs 60 %, p=0.004). No patient had normal ECG at the time of death. Except for a taller R wave in V2 (0.3 vs 0.7 mV, p=0.03), no significant ECG changes were observed between patients who died directly from PAH versus other causes.

CONCLUSIONS: Significant changes occur in a variety of ECG parameters between the time of the initial diagnosis and the advanced disease state before death.

CLINICAL IMPLICATIONS: Several ECG changes are observed between the time of initial PAH diagnosis and death. ECG parameters that changed over time could be candidates for prospective studies as markers of disease progression, response to therapy, and overall prognosis.

DISCLOSURE: The following authors have nothing to disclose: Manfred Baumgartner, Omar Minai, Jennie Newman, Raed Dweik, Adriano Tonelli

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Cleveland Clinic Foundation, Cleveland, OH




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