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Prognostic Indicators on the Electrocardiogram in Pulmonary Arterial Hypertension

Eric Fenstad

R Le

Michael McGoon

T. Munger

Robert Frantz

Garvan Kane


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Conference: 2012 International PHA Conference and Scientific Sessions

Release Date: 06.22.2012

Presentation Type: Abstracts

Fenstad E1, Le R2, McGoon M1, Munger T1, Frantz R1, and Kane G1.

Division of Cardiovascular Diseases1, Department of Internal Medicine2, Mayo Clinic, Rochester, MN, USA.

BACKGROUNDElectrocardiographic findings in patients with pulmonary arterial hypertension (PAH) have been described previously in a small subset of patients with Scleroderma. However, in patients with PAH the prognostic significance of these findings remains unknown.

METHODSSingle center study of consecutive patients diagnosed with PAH at a specialty Pulmonary Hypertension center between 1995-2005 (N=422). Mortality was censored at transplant or at 5 years. Twelve lead electrocardiograms were reviewed by a single investigator blinded to outcomes. Definition of Right atrial enlargement (RAE) and right ventricular hypertrophy (RVH) utilized composite criteria.

RESULTSAverage heart rate was 82 ± 15 bpm. The majority of patients (55%) had idiopathic PAH and 73% were WHO functional class III-IV. Right and LBBB as well as intraventricular conduction delay were uncommon, 6.2%, 0.7%, and 4% respectively, yet 145 patients (34%) met criteria for incomplete RBBB. Incomplete and complete bundle branch block were not associated with adverse outcome. However, when characterized by PAH etiology, patients with idiopathic PAH and QRS < 104 ms (75th interquartile) had a survival benefit. Right atrial enlargement was evident in 176 (52%) patients while 328 (78%) patients had evidence of RVH. P wave amplitude was not related to outcome. Presence of tachycardia, RAE, or RVH on electrocardiogram 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. 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)].

CONCLUSIONSThese simple, prevalent, and easily obtainable findings on the index electrocardiogram predict outcome. Prolonged QRS was uncommon and not associated with outcome in this cohort.