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First published online on July 18, 2008
Chest, doi:10.1378/chest.08-0461
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Electrocardiographic monitoring of treatment response in pulmonary arterial hypertension patients

Ivo R. Henkens, MD1; C. Tji-Joong Gan , MSc2; Serge A. van Wolferen, MD2; Miki Hew, MSc1; Anco Boonstra, MD, PhD2; Jos W.R. Twisk3; Otto Kamp, MD, PhD4; Ernst E. van der Wall, MD, PhD1; Martin J. Schalij, MD, PhD1; Anton Vonk Noordegraaf, MD, PhD2 and Hubert W. Vliegen, MD, PhD1

1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 PO Box 9600, 2300 RC Leiden, the Netherlands 2Department of Pulmonology, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands 3Department Clinical Epidemiology and Biostatistics, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands 4Department of Cardiology, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands

a.vonk{at}vumc.nl

Abstract

BackgroundThe potential use of the electrocardiogram for monitoring treatment effect in patients with pulmonary arterial hypertension (PAH) has not been investigated. We evaluated whether the ECG is useful for monitoring treatment response based on changes in pulmonary vascular resistance (PVR).

MethodsAn ECG was recorded in 81 PAH patients at the time of diagnostic right heart catheterization, and after one year of treatment. Patients were treated according to the guidelines. Patients were divided into two groups based on PVR (<500 dynes·s·cm-5 or >500 dynes·s·cm-5). A positive treatment response was defined as >25% decrease in PVR to an absolute PVR<500 dynes·s·cm-5.

ResultsAt baseline, the 19 patients with a PVR<500 dynes·s·cm-5 had a significantly lower P amplitude in lead II, a less rightward oriented QRS axis, and a more rightward T axis than the 62 patients with a PVR>500 dynes·s·cm-5. Overall (n=81), mean change in PVR was -143±360 dynes·s·cm-5 after one year of treatment (P<0.001). Twelve patients (19%) with a baseline PVR>500 dynes·s·cm-5 classified as responders. Receiver operating characteristics analysis determined that P amplitude in lead II (AUC=0.80, 95% CI, 0.67-0.94, P<0.01), QRS axis (AUC=0.70, 95% CI, 0.52-0.89, P=0.03), and T axis (AUC=0.90, 95% CI, 0.82-0.97, P<0.001) were important determinants of treatment response. Presence of P amplitude in lead II<0.175mV, and T axis≥25° combined, had a positive and negative predictive value for treatment response of 0.81(CI, 0.37-0.96) and 0.94 (CI, 0.86-0.99), respectively.

ConclusionsRoutine ECG evaluation can be an important contribution in the assessment of treatment response in PAH patients.

Key Words: pulmonary hypertension • monitoring • electrocardiogram • pulmonary circulation






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