Henkens Ivo R, Gan C Tji-Joong, van Wolferen Serge A, Hew Miki, Boonstra Anco, Twisk Jos W R, Kamp Otto, van der Wall Ernst E, Schalij Martin J, Vonk Noordegraaf Anton, Vliegen Hubert W
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Department of Pulmonology, VU University Medical Center, Amsterdam, the Netherlands.
Chest. 2008 Dec;134(6):1250-1257. doi: 10.1378/chest.08-0461. Epub 2008 Jul 18.
The potential use of the ECG for monitoring treatment effects 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).
An ECG was recorded in 81 PAH patients at the time of diagnostic right heart catheterization and after 1 year of treatment. Patients were treated according to the guidelines. Patients were divided into two groups based on PVR (ie, < 500 or > 500 dyne x s x cm(-5)). A positive treatment response was defined as a > 25% decrease in PVR to an absolute PVR of < 500 dyne x s x cm(-5).
At baseline, the 19 patients with a PVR of < 500 dyne x s x 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 of > 500 dyne x s x cm(-5). Overall (n = 81), the mean (+/- SD) change in PVR was -143 +/- 360 dyne x s x cm(-5) after 1 year of treatment (p < 0.001). Twelve patients (19%) with a baseline PVR of > 500 dyne x s x cm(-5) were classified as responders. Receiver operating characteristic analysis determined that the P amplitude in lead II (area under the curve [AUC], 0.80; 95% confidence interval [CI], 0.67 to 0.94; p < 0.01), QRS axis (AUC, 0.70; 95% CI, 0.52 to 0.89; p = 0.03), and T axis (AUC, 0.90; 95% CI, 0.82 to 0.97; p < 0.001) were important determinants of treatment response. The presence of a P amplitude in lead II of < 0.175 mV and a T axis of >or= 25 degrees combined had a positive and negative predictive value for treatment response of 0.81 (95% CI, 0.37 to 0.96) and 0.94 (95% CI, 0.86 to 0.99), respectively.
Routine ECG evaluation can be an important contribution in the assessment of treatment response in PAH patients.
尚未对心电图在监测肺动脉高压（PAH）患者治疗效果方面的潜在用途进行研究。我们评估了基于肺血管阻力（PVR）变化，心电图是否有助于监测治疗反应。
在81例PAH患者进行诊断性右心导管检查时及治疗1年后记录心电图。患者按指南进行治疗。根据PVR将患者分为两组（即<500或>500达因×秒×厘米⁻⁵）。阳性治疗反应定义为PVR下降>25%，降至绝对PVR<500达因×秒×厘米⁻⁵。
基线时，19例PVR<500达因×秒×厘米⁻⁵的患者与62例PVR>500达因×秒×厘米⁻⁵的患者相比，II导联P波振幅显著更低，QRS电轴右偏程度更小，T电轴右偏程度更大。总体而言（n = 81），治疗1年后PVR的平均（±标准差）变化为-143±360达因×秒×厘米⁻⁵（p<0.001）。12例（19%）基线PVR>500达因×秒×厘米⁻⁵的患者被归类为反应者。受试者工作特征分析确定，II导联P波振幅（曲线下面积[AUC]，0.80；95%置信区间[CI]，0.67至0.94；p<0.01）、QRS电轴（AUC，0.70；95%CI，0.52至0.89；p = 0.03）和T电轴（AUC，0.90；95%CI，0.82至0.97；p<0.001）是治疗反应的重要决定因素。II导联P波振幅<0.175mV且T电轴≥25°同时存在时，对治疗反应的阳性和阴性预测值分别为0.81（95%CI，0.37至0.96）和0.94（95%CI，0.86至0.99）。
常规心电图评估对评估PAH患者的治疗反应可能有重要作用。
