The evolution of electrocardiographic signs of right ventricular overload after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Pol Arch Intern Med. 2019 Aug 29;129(7-8):451-459. doi: 10.20452/pamw.14877. Epub 2019 Jun 25.

Abstract

Introduction: Balloon pulmonary angioplasty (BPA) is a treatment option for a patient with chronic thromboembolic pulmonary hypertension.

Objectives: We aimed to investigate the evolution of electrocardiographic (ECG) markers of right ventricular hypertrophy (RVH) after BPA.

Patients and methods: Standard 12‑lead ECG was performed in 41 patients with chronic thromboembolic pulmonary hypertension before the first BPA and after completion of treatment.

Results: In the whole study group, the percentage change in the pulmonary vascular resistance (PVR) after BPA correlated with the percentage change in the values of the following ECG parameters (P <0.05): axis of the QRS (rho = 0.530) and T wave (rho = 0.372); P wave in leads II (rho = 0.340) and III (rho = 0.430); S wave in lead V5 (rho = 0.634); R/S ratio in lead V5 (rho = -0.636); S wave in lead V6 (rho = 0.508); S wave in lead I (rho = 0.496). Then, the group was divided into 2 subgroups: group A, defined as a drop in PVR greater than the median value (49%) for the whole study population; and group B, defined as a drop in PVR below the median value. In group A, the following parameters changed after BPA: T‑wave axis (P <0.001), P wave in lead II (P <0.001), S wave in lead V5 (P <0.001), R/S ratio in lead V5 (P <0.001). In group B, despite some hemodynamic and functional improvement, there were no differences in ECG mark ers of RVH after BPA.

Conclusions: An improvement in RVH parameters can be observed on ECG after a hemodynamically effective BPA.

MeSH terms

  • Aged
  • Angioplasty, Balloon
  • Electrocardiography*
  • Female
  • Hemodynamics
  • Humans
  • Hypertension, Pulmonary / complications*
  • Hypertension, Pulmonary / therapy
  • Hypertrophy, Right Ventricular / diagnosis
  • Hypertrophy, Right Ventricular / etiology*
  • Hypertrophy, Right Ventricular / physiopathology*
  • Male
  • Middle Aged
  • Pulmonary Artery / physiopathology*