Abstract 12201: QRS Complex Duration Predicts Outcome in Children With Pulmonary Hypertensive Vascular Disease
Background: QRS complex duration may reflect right ventricular (RV) size and dysfunction. Increased RV size and dysfunction predict a poor outcome in children with pulmonary hypertensive vascular disease (PHVD). We investigated the association of QRS duration with pulmonary vascular hemodynamics and outcome in children with PHVD.
Methods: We reviewed the clinical data of children with PHVD who had an ECG recorded within 1 week of cardiac catheterization between 2009-13. We excluded patients with congenital heart disease. The QRS duration was measured in lead V1 using the TM ECGvue application (Philips, Netherlands). Pulmonary artery (PA) pressures were measured directly and pulmonary vascular resistance (PVRI) and pulmonary capacitance index (PACI) were calculated using measured oxygen consumption.
Results: 32 patients (17 males), median age 4 years (range 3 months to 17 years), median weight 13.9 kg (range 3.3 to 77) underwent 46 cardiac catheterizations. Diagnoses included idiopathic pulmonary arterial hypertension (58%), left heart disease (14%) and bronchopulmonary dysplasia (28%). There were 4 deaths due to right heart failure and one patient required lung transplantation. One patient with good right ventricular function but hemoptysis from bronchial collaterals died of complications after embolization. Mean QRS duration was 85 ± 17 ms (upper limit of normal for age range 75-85 ms). QRS duration > 93 ms predicted death or lung transplantation due to right heart failure (sensitivity 100%, specificity 68%) and PACI ≤ 0.7ml/mmHg/m2 (sensitivity 70%, specificity 75%). The mean PA pressure was 43 ± 18 mmHg, PVRI 9.6 ± 6 WU.m2, PACI 1.13 ± 0.8 ml/mmHg/m2. QRS duration correlated with the systolic PA pressure (r=+0.26, p=0.03), mean PA pressure (r=+0.26, p=0.03) and PVRI (r=+0.3, p=0.006) and negatively with the PACI (r=-0.45, p≤0.001).
Conclusion: In children with PHVD, a QRS duration > 93 ms predicts death from right heart failure with 100% sensitivity. A QRS of >93 ms maybe a useful, easily obtainable, non-invasive indicator of children who require close follow up and further evaluation.
- © 2013 by American Heart Association, Inc.