Abstract 15999: Electrocardiographic Changes Associated With Prognosis in Pulmonary Arterial Hypertension
Introduction: Electrocardiographic findings in patients with pulmonary arterial hypertension (PAH) have been described previously in a small cohort. However the prognostic significance of these findings remains unknown in patients with Group 1 PAH.
Hypothesis: Evidence of right ventricular hypertrophy on ECG will portend a poor prognosis in PAH.
Methods: Single center retrospective study of 422 consecutive patients diagnosed with Group 1 PAH at a specialty Pulmonary Hypertension center between 1995-2005. Mortality was assessed over 5 years. Twelve lead electrocardiograms were reviewed by a blinded single investigator. Standard definitions were used for right atrial enlargement (RAE) and composite criteria defined right ventricular hypertrophy (RVH).
Results: Average heart rate was 82 ± 15 bpm. Right atrial enlargement was seen in 176 (52%) patients while 328 (78%) patients had evidence of RVH. Presence of tachycardia, RAE, or RVH predicted right heart catheterization characteristics of poor prognosis (higher right atrial pressure, lower cardiac index, & higher pulmonary vascular resistance). Adjusted for age & sex, tachycardia (Hazard ratio 1.70; 95% CI 1.17, 2.40), RAE (HR 1.47; 95% CI 1.11, 1.94) and RVH (HR 1.95; 95% CI 1.37, 2.86) were associated with five year mortality (Figure 1A and 1B). These parameters remained predictive of death when also adjusted for age, sex and functional class [tachycardia (HR 1.59; 95% CI 1.09, 2.25), RAE (HR 1.41; 95% CI 1.07, 1.86) and RVH (HR 1.81; 95% CI 1.27, 2.65)].
Conclusions: Tachycardia and the presence of electrocardiographic evidence of RAE or RVH indicate a poor prognosis in PAH.
- © 2011 by American Heart Association, Inc.