Simple electrocardiographic features of importance for prognosis in severe chronic bronchial obstruction.

228 patients between 40-69 years old, with chronic bronchila obstruction (FEV1 1.51/s or less) mainly due to chronic bronchitis were investigated by means of E.C.G. examinations. All patients had been referred to hospital for treatment or examination. Prognosis regarding survival after 4 years was calculated for various values of QRS axis, PII amplitude, and ischaemic changes in E.C.G. Survival was very poor in the groups of patients with an E.C.G. showing a QRS axis +90 degrees to +180 degrees and a PII amplitude of 0.20 mV or more. Only 37% and 42% of the patients with these respective changes were alive after 4 years. There was a 65% survival among patients with only ischaemic changes in E.C.G. This last result was based on few patients and probably influenced by selection. It was not significantly different from the 75% survival after 4 years among patients with normal E.C.G. Age and severity of bronchial obstruction had a small additional influence on survival in patients with abnormal E.C.G. Survival was nearly the same for all age groups and for all degrees of obstruction in patients with normal E.C.G. Patients with abnormalities in R/S in precordial leads V1 or V6 usually had abnormal extremity leads also. The patients who had changes in precordial leads as well as standard leads had a very low survival after 4 years. Patients with changes only in standard leads had a significantly better survival than patients with changes in precordial leads as well, but a significantly lower survival after 4 years than patients with normal E.C.G. It is suggested that an E.C.G. with a QRS axis +90 degrees to +180 degrees and/or a PII amplitude 0.20 mV or more in patients with bronchial obstruction indicates the presence of cor pulmonale even when precordial leads are normal. Survival in the first 4 to 6 years in patients with severe chronic bronchial obstruction is mainly related to the presence or absence of electrocardiographic signs of cor pulmonale rather than to the degree of obstruction.