title: Significance of electrocardiographic right ventricular hypertrophy in patients with pulmonary hypertension with or without right ventricular systolic dysfunction.
abstract: OBJECTIVE
  We sought to determine the value of electrocardiographic right ventricular hypertrophy (ECG-RVH) in pulmonary hypertension (PH) patients with right ventricular systolic dysfunction defined by cardiac magnetic resonance (CMR-RVSD).
  
  
  METHODS
  A total of 31 consecutive patients with PH with a mean pulmonary arterial pressure of >25 mmHg underwent both ECG and CMR studies. Patients were divided into 2 groups according to the presence of RVSD, defined as a RV ejection fraction <35%. Logistic regression modeling was performed to define the association between ECG-RVH and CMR-RVSD.
  
  
  RESULTS
  About half of the patients had RVSD (n=15 ; 48%). The R to S wave ratio (p=0.01) or incidence of qR pattern (p=0.002) in lead V(1) was significantly greater in patients with PH complicated by RVSD than in those without RVSD. These 2 patterns were significant predictors of RVSD [odds ratio (OR), 19.3 for qR; OR, 14.0 for R/S>1] and when each of these ECG findings was assigned with a point proportional to OR (score of 2 for qR in lead V(1) and score of 1 for R/S>1 in lead V(1)), the incidence of RVSD increased by the total ECG score.
  
  
  CONCLUSIONS
  The combination of ECG-RVH findings, especially in lead V(1), predicts the presence of RVSD defined by CMR. ECG might be a useful tool for estimating the presence of RVSD in patients with PH.
authors.affiliation: Division of Cardiology, Department of Medicine, Keio University School of Medicine, Japan. umc-nagai@hotmail.co.jp
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nagai
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.forename: Mitsushige
authors.initials: M
authors.lastname: Murata
authors.forename: Shigeo
authors.initials: S
authors.lastname: Okuda
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Anzai
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fukuda
authors.forename: Toru
authors.initials: T
authors.lastname: Satoh
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D015897:Comorbidity; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology* / Q000503:physiopathology; D017380:Hypertrophy, Right Ventricular / Q000453:epidemiology* / Q000503:physiopathology; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology