Tonelli Adriano R, Baumgartner Manfred, Alkukhun Laith, Minai Omar A, Dweik Raed A
Department of Pulmonary, Allergy, and Critical Care Medicine, Respiratory Institute, Cleveland, OH.
Ann Noninvasive Electrocardiol. 2014 May;19(3):258-65. doi: 10.1111/anec.12125. Epub 2013 Dec 30.
Scarce information exits on the electrocardiographic (ECG) characteristics of pulmonary arterial hypertension (PAH) patients close to their death and whether observed abnormalities progress from the time of PAH diagnosis.
We analyzed the characteristics of the ECG performed at initial diagnosis, during the course of the disease and close to the time of death on consecutive PAH patients followed at our institution between June 2008 and December 2010.
We included 50 patients with PAH (76% women) with mean (SD) age of 58 (14) years. Median heart rate (83 vs 89 bpm, P = 0.001), PR interval (167 vs 176 ms, P = 0.03), QRS duration (88 vs 90 ms, P = 0.02), R/S ratio in lead V1 (1 vs 2, P = 0.01), and QTc duration (431 vs 444 ms, P = 0.02) significantly increased from the initial to the last ECG. In addition, the frontal QRS axis rotated to the right (97 vs 112 degrees, P = 0.003) and we more commonly observed right bundle branch block (5% vs 8%, P = 0.03) and negative T waves in inferior leads (31% vs 60%, P = 0.004). No patient had normal ECG at the time of death.
Significant changes progressively occur in a variety of ECG parameters between the time of the initial PAH diagnosis and close to death.
关于肺动脉高压（PAH）患者临终时的心电图（ECG）特征以及自PAH诊断之时起所观察到的异常情况是否会进展，现有信息匮乏。
我们分析了2008年6月至2010年12月在我们机构连续随访的PAH患者在初始诊断时、疾病过程中以及临近死亡时所做心电图的特征。
我们纳入了50例PAH患者（76%为女性），平均（标准差）年龄为58（14）岁。从首次心电图到最后一次心电图，心率中位数（83对89次/分钟，P = 0.001）、PR间期（167对176毫秒，P = 0.03）、QRS时限（88对90毫秒，P = 0.02）、V1导联R/S比值（1对2，P = 0.01）以及QTc时限（431对444毫秒，P = 0.02）均显著增加。此外，额面QRS电轴向右旋转（97对112度，P = 0.003），我们更常观察到右束支传导阻滞（5%对8%，P = 0.03）以及下壁导联T波倒置（31%对60%，P = 0.004）。死亡时无患者心电图正常。
从PAH初始诊断到临近死亡期间，多种心电图参数逐渐发生显著变化。
