title: Electrocardiography to define clinical status in primary pulmonary hypertension and pulmonary arterial hypertension secondary to collagen vascular disease.
abstract: OBJECTIVE
  To determine the utility of the ECG for predicting clinical status in adults with primary pulmonary hypertension (PPH) or pulmonary arterial hypertension (PAH) secondary to collagen vascular disease.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Outpatient clinic in a tertiary referral center.
  
  
  METHODS
  Adult outpatients with PPH or PAH secondary to collagen vascular disease who underwent electrocardiography within 30 days of undergoing right-heart catheterization, echocardiography, and 6-min walk testing.
  
  
  METHODS
  None.
  
  
  RESULTS
  The following measurements were recorded from each ECG: P-wave amplitude in lead II; mean frontal QRS axis; QRS duration; R-wave and S-wave deflections in leads I and V6; and the T-wave configurations in the precordial leads. These ECG variables were correlated with hemodynamic variables, RV size, and exercise capacity. Of the 61 patients included in this study, 56 (92%) were women. Eight of 61 patients (13%) had normal findings on ECGs. There was no significant difference in the demographics or hemodynamics when comparing groups with normal vs abnormal ECGs. All ECG parameters had no more than moderate correlation with hemodynamic variables, ventricular size measured by echocardiogram, and exercise capacity as measured by a 6-min walk. The best correlation was between mean the frontal QRS axis and cardiac index (r = -0.46).
  
  
  CONCLUSIONS
  The ECG is an inadequate screening tool to rule out the presence of clinically relevant pulmonary hypertension, either primary or secondary to collagen vascular disease. The mean frontal QRS axis correlated best with the severity of hemodynamic impairment.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Ahearn
authors.forename: Victor F
authors.initials: VF
authors.lastname: Tapson
authors.forename: Abdallah
authors.initials: A
authors.lastname: Rebeiz
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Greenfield
mesh_terms: D006328:Cardiac Catheterization; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014652:Vascular Diseases / Q000150:complications*