ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology
Remembering the Occam’s Razor: Could Simple Electrocardiographic Findings Provide Relevant Predictions for Current Hemodynamic Criteria of Pulmonary Hypertension? [Anatol J Cardiol]
Anatol J Cardiol. 2023; 27(11): 664-672 | DOI: 10.14744/AnatolJCardiol.2023.3181

Remembering the Occam’s Razor: Could Simple Electrocardiographic Findings Provide Relevant Predictions for Current Hemodynamic Criteria of Pulmonary Hypertension?

Hacer Ceren Tokgöz1, Bahadır Erdem Öcal2, Yiğit Cengiz Erkuş3, Seda Tanyeri4, Barkın Kültürsay1, Ayhan Tosun1, Berhan Keskin1, Aykun Hakgör5, Dicle Sırma1, Çağdaş Buluş1, Ali Karagöz1, İbrahim Halil Tanboğa6, Şeyhmus Külahçıoğlu1, Zübeyde Bayram1, Ahmet Sekban1, Nihal Özdemir1, Cihangir Kaymaz1
1Department of Cardiology, University of Health Sciences, Koşuyolu Heart Training and Research Hospital, İstanbul, Türkiye
2Faculty of Medicine, Marmara University, İstanbul, Türkiye
3Hamidiye Faculty of Medicine, University of Health Sciences, İstanbul, Türkiye
4Department of Cardiology, University of Health Sciences, Derince Training and Research Hospital, Kocaeli, Türkiye
5Department of Cardiology, Faculty of Medicine, Medipol University, İstanbul, Türkiye
6Department of Cardiology, Faculty of Medicine, Nişantaşı University, İstanbul, Türkiye

Background: We evaluated the predictive value of electrocardiographic (ECG) findings for pulmonary hemodynamics assessed by right heart catheterization (RHC).

Methods: Our study population comprised 562 retrospectively evaluated patients who underwent RHC between 2006 and 2022. Correlations between ECG measures and pulmonary arterial systolic and mean pressures (PASP and PAMP) and pulmonary vascular resistance (PVR) were investigated. Moreover, receiver operating characteristic (ROC) curve analysis assessed the predictive value of ECG for pulmonary hypertension (PH) and precapillary PH.

Results: The P-wave amplitude (Pwa) and R/S ratio (r) in V1 and V2, Ra in augmented voltage right (aVR), right or indeterminate axis, but not P wave duration (Pwd) or right bundle branch block (RBBB) significantly correlated with PASP, PAMP, and PVR (P <.001 for all). The partial R2 analysis revealed that amplitude of R wave (Ra) in aVR, R/Sr in V1 and V2, QRS axis, and Pwa added to the base model provided significant contributions to variance for PASP, PAMP, and PVR, respectively. The Pwa > 0.16 mV, Ra in aVR > 0.05 mV, QRS axis > 100° and R/Sr in V1 > 0.9 showed the highest area under curve (AUC) values for PAMP > 20 mm Hg. Using the same cutoff value, Ra in aVR, Pwa, QRS axis, and R/Sr in V1 showed highest predictions for PVR > 2 Wood Units (WU).

Conclusion: In this study, Pwa, Ra in aVR, right or indeterminate axis deviations, and R/Sr in V1 and V2 showed statistically significant correlations with pulmonary hemodynamics, and Ra in aVR, R/Sr in V2 and V1, QRS axis, and Pwa contributed to variance for PASP, PAMP, and PVR, respectively. Moreover, Pwa, Ra in aVR, QRS axis, and R/Sr in V1 seem to provide relevant predictions for PH and precapillary PH.

Keywords: Electrocardiogram, QRS axis, pulmonary hypertension

Hacer Ceren Tokgöz, Bahadır Erdem Öcal, Yiğit Cengiz Erkuş, Seda Tanyeri, Barkın Kültürsay, Ayhan Tosun, Berhan Keskin, Aykun Hakgör, Dicle Sırma, Çağdaş Buluş, Ali Karagöz, İbrahim Halil Tanboğa, Şeyhmus Külahçıoğlu, Zübeyde Bayram, Ahmet Sekban, Nihal Özdemir, Cihangir Kaymaz. Remembering the Occam’s Razor: Could Simple Electrocardiographic Findings Provide Relevant Predictions for Current Hemodynamic Criteria of Pulmonary Hypertension?. Anatol J Cardiol. 2023; 27(11): 664-672

Corresponding Author: Cihangir Kaymaz, Türkiye
Manuscript Language: English


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