title: Role of electrocardiographic changes in discriminating acute or chronic right ventricular pressure overload.
abstract: OBJECTIVE
  Pulmonary embolism (PE) and severe pulmonary stenosis (PS) are two distinct conditions accompanied by increased pressure load of the right ventricle (RV). Despite major advances in our understanding of the mechanisms of RV adaptation to the increased pressure, substantial gaps in our knowledge remain unsettled. One of much less known aspect of pressure overload of RV is its impact on electrocardiographic (ECG) changes. In this study, we aimed to study whether acute and chronic RV overload are accompanied by different ECG patterns.
  
  
  METHODS
  Thirty-eight patients with PE underwent ECG monitoring were compared with 20 matched patients with PS in this observational retrospective study. ECG abnormalities suggestive of RV overload were recorded and analyzed in both groups. Logistic regression analysis was used to define the predictors of chronic RV overload.
  
  
  RESULTS
  Among the ECG changes studied, premature atrial contraction (OR-12.2, 95% CI, 1.3-107, p=0.008), right axis deviation (OR-20.4, 95% CI 4.2-98, p<0.001), indeterminate axis (OR-0.11, 95% CI 0.02-0.44, p=0.001 0.11), incomplete right bundle branch block (OR-4.2, 95% CI, 1.1-15.4, p=0.02), late R in aVR (OR-8.4, 95% CI 2.1-33.2, p=0.001), qR in V1 lead (OR-8.3, 95% CI 1.2-74.8, p=0.03) were found to be the independent predictors of chronic RV pressure overload.
  
  
  CONCLUSIONS
  Our data indicate that the ECG changes that attributed to the acute RV pressure loading states may be more prevalent in chronic RV overload as compared with acute RV overload.
authors.affiliation: Department of Cardiology, GATA Haydarpaşa Education and Research Hospital, İstanbul-Turkey. mehmetmustafacan@yahoo.com
authors.forename: Mehmet Mustafa
authors.initials: MM
authors.lastname: Can
authors.forename: Olcay
authors.initials: O
authors.lastname: Özveren
authors.forename: Murat
authors.initials: M
authors.lastname: Biteker
authors.forename: Cihan
authors.initials: C
authors.lastname: Şengül
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Uz
authors.forename: Zafer
authors.initials: Z
authors.lastname: Işılak
authors.forename: Ata
authors.initials: A
authors.lastname: Kırılmaz
mesh_terms: D000208:Acute Disease; D000328:Adult; D006328:Cardiac Catheterization; D016022:Case-Control Studies; D002908:Chronic Disease; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017380:Hypertrophy, Right Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies