Waligóra Marcin, Gliniak Matylda, Bylica Jan, Pasieka Paweł, Łączak Patrycja, Podolec Piotr, Kopeć Grzegorz
Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Krakow, 31-202 Krakow, Poland.
Students' Scientific Group of Pulmonary Circulation and Thromboembolic Diseases, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland.
J Clin Med. 2021 May 16;10(10):2147. doi: 10.3390/jcm10102147.
In pulmonary hypertension (PH), T wave inversions (TWI) are typically observed in precordial leads V1-V3 but can also extend further to the left-sided leads. To date, the cause and prognostic significance of this extension have not yet been assessed. Therefore, we aimed to assess the relationship between heart morphology and precordial TWI range, and the role of TWI in monitoring treatment efficacy and predicting survival. We retrospectively analyzed patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) treated in a reference pulmonary hypertension center. Patients were enrolled if they had a cardiac magnetic resonance (cMR) and 12-lead surface ECG performed at the time of assessment. They were followed from October 2008 until March 2021. We enrolled 77 patients with PAH and 56 patients with inoperable CTEPH. They were followed for a mean of 51 ± 33.5 months, and during this time 47 patients died (35.3%). Precordial TWI in V1-V6 were present in 42 (31.6%) patients, while no precordial TWI were observed only in 9 (6.8%) patients. The precordial TWI range correlated with markers of PH severity, including right ventricle to left ventricle volume RVEDVLVEDV (R = 0.76, < 0.0001). The presence of TWI in consecutive leads from V1 to at least V5 predicted severe RV dilatation (RVEDVLVEDV ≥ 2.3) with a sensitivity of 88.9% and specificity of 84.1% (AUC of 0.90, 95% CI = 0.83-0.94, < 0.0001). Presence of TWI from V1 to at least V5 was also a predictor of mortality in Kaplan-Meier estimation ( = 0.02). Presence of TWI from V1 to at least V5 had a specificity of 64.3%, sensitivity of 58.1%, negative predictive value of 75%, and positive predictive value of 45.5% as a mortality predictor. In patients showing a reduction in TWI range of at least one lead after treatment compared with patients without this reduction, we observed a significant improvement in RV-EDV and RV-EDVLV-EDV. We concluded that the extension of TWI to left-sided precordial leads reflects significant pathological alterations in heart geometry represented by an increase in RV/LV volume and predicts poor survival in patients with PAH and CTEPH. Additionally, we found that analysis of precordial TWI range can be used to monitor the effectiveness of hemodynamic response to treatment of pulmonary hypertension.
在肺动脉高压（PH）中，T波倒置（TWI）通常出现在胸前导联V1-V3，但也可能进一步延伸至左侧导联。迄今为止，这种延伸的原因及预后意义尚未得到评估。因此，我们旨在评估心脏形态与胸前TWI范围之间的关系，以及TWI在监测治疗效果和预测生存方面的作用。我们回顾性分析了在一家参考肺动脉高压中心接受治疗的肺动脉高压（PAH）和慢性血栓栓塞性肺动脉高压（CTEPH）患者。如果患者在评估时进行了心脏磁共振成像（cMR）和12导联体表心电图检查，则纳入研究。他们从2008年10月至2021年3月接受随访。我们纳入了77例PAH患者和56例无法手术的CTEPH患者。他们的平均随访时间为51±33.5个月，在此期间有47例患者死亡（35.3%）。42例（31.6%）患者胸前V1-V6导联出现TWI，而仅9例（6.8%）患者未观察到胸前TWI。胸前TWI范围与PH严重程度标志物相关，包括右心室与左心室容积比RVEDV/LVEDV（R = 0.76，P < 0.0001）。从V1到至少V5连续导联出现TWI预测严重右心室扩张（RVEDV/LVEDV≥2.3）的敏感性为88.9%，特异性为84.1%（AUC为0.90，95%CI = 0.83 - 0.94，P < 0.0001）。在Kaplan-Meier估计中，从V1到至少V5出现TWI也是死亡的预测指标（P = 0.02）。作为死亡预测指标，从V1到至少V5出现TWI的特异性为64.3%，敏感性为58.1%，阴性预测值为75%，阳性预测值为45.5%。与未出现这种降低的患者相比，治疗后TWI范围至少减少一个导联的患者，我们观察到右心室舒张末期容积（RV-EDV）和RV-EDV/LV-EDV有显著改善。我们得出结论，TWI延伸至左侧胸前导联反映了以右心室/左心室容积增加为代表的心脏几何结构的显著病理改变，并预测PAH和CTEPH患者的生存不良。此外，我们发现分析胸前TWI范围可用于监测肺动脉高压治疗的血流动力学反应效果。
