Goncalvesova E, Luknar M, Lesny P
Heart Failure and Transplant Department, National Institute of Cardiovascular Disease, Bratislava, Slovakia.
Bratisl Lek Listy. 2011;112(11):614-8.
Distinguishing pulmonary arterial hypertension (PAH) and pulmonary hypertension due to left ventricular diastolic dysfunction (PHLDD) is essential for the correct disease management. We compared the importance of electrocardiographic (ECG) signs of right ventricular hypertrophy (RVH) in patients with similar degree PAH and PHLDD.
ECG analysis was retrospectively performed in 17 PHLDD and in 17 PAH patients with catheterization-confirmed moderate pulmonary hypertension. Sensitivity, specificity, and positive and negative predictive values for individual RVH signs were calculated.
The PAH group showed a higher prevalence of the following: R/S ratio > 1 in V1 (p < 0.001), R in V1 + S in V6 > 1.05 mV (p < 0.01), R wave peak time > 0.035 s (p < 0.05), right ventricular strain (p < 0.001), and A+R-PL parameter (i. e. R(V1) + S1 - S(V1)) = 0.07 mV (p < 0.05). The sensitivity and negative predictive value (NPV) of RVH signs for distinguishing PAH and PHLDD were low for all signs except right ventricular strain (sensitivity 71%, NPV 77%). The specificity and positive predictive value (PPV) of all six parameters were both 100%.
In patients with pulmonary hypertension detected using echocardiography, ECG presence of RVH/overload may exclude LV diastolic dysfunction as a cause of PH and suggests the diagnosis of PAH (Tab. 3, Ref. 19).
区分肺动脉高压（PAH）和左心室舒张功能障碍所致肺动脉高压（PHLDD）对于正确的疾病管理至关重要。我们比较了右心室肥厚（RVH）的心电图（ECG）征象在PAH和PHLDD程度相似患者中的重要性。
对17例PHLDD患者和17例经导管检查确诊为中度肺动脉高压的PAH患者进行回顾性心电图分析。计算各个RVH征象的敏感性、特异性、阳性预测值和阴性预测值。
PAH组以下情况的发生率更高：V1导联R/S比值>1（p<0.001），V1导联R波+V6导联S波>1.05 mV（p<0.01），R波峰时间>0.035 s（p<0.05），右心室劳损（p<0.001），以及A+R-PL参数（即R(V1)+S1-S(V1)）=0.07 mV（p<0.05）。除右心室劳损外（敏感性71%，阴性预测值77%），所有RVH征象区分PAH和PHLDD的敏感性和阴性预测值均较低。所有六个参数的特异性和阳性预测值均为100%。
在经超声心动图检测出肺动脉高压的患者中，ECG显示RVH/负荷过重可能排除左心室舒张功能障碍作为PH的病因，并提示PAH的诊断（表3，参考文献19）。
