title: The role of electrocardiography in evaluation of severity of chronic obstructive pulmonary disease in daily clinical practice.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of chronic morbidity and mortality. Bronchial obstruction and increased pulmonary vascular resistance impairs right atrial functions. In this study, we aimed to investigate the effect of bronchial obstruction on p wave axis in patients with COPD and usefulness of electrocardiography (ECG) in the evaluation of the severity of COPD.
  
  
  METHODS
  Ninety five patients (64 male and 31 female) included to the study. Patients were in sinus rhythm, with normal ejection fraction and heart chamber sizes. Their respiratory function tests and 12 lead electrocardiograms were obtained at same day. Correlations with severity of COPD and ECG findings including p wave axis, p wave duration, QRS axis, QRS duration were studied.
  
  
  RESULTS
  The mean age was 58 ± 12 years. Their mean p wave axis was 62 ± 18 degrees. In this study, p wave axis has demonstrated significant positive correlations with stages of COPD and QRS axis but significant negative correlations with FEV1, FEF, BMI and QRS duration. P wave axis increases with increasing stages of COPD.
  
  
  CONCLUSIONS
  Verticalization of the frontal p wave axis may be an early finding of worsening of COPD before occurrences of other ECG changes of hypertrophy and enlargement of right heart chambers such as p pulmonale. Verticalization of the frontal p wave axis reflecting right atrial electrical activity and right heart strain may be a useful parameter for quick estimation of the severity of COPD in an out-patient cared.
authors.affiliation: Clinic of Cardiology, Istanbul Mehmet Akif Ersoy Chest and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey. farukakturk@gmail.com
authors.forename: Faruk
authors.initials: F
authors.lastname: Aktürk
authors.forename: İsmail
authors.initials: İ
authors.lastname: Bıyık
authors.forename: Cüneyt
authors.initials: C
authors.lastname: Kocaş
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ertürk
authors.forename: Ahmet Arif
authors.initials: AA
authors.lastname: Yalçın
authors.forename: Ayfer Utku
authors.initials: AU
authors.lastname: Savaş
authors.forename: Firuzan Pınar
authors.initials: FP
authors.lastname: Kuzer
authors.forename: Fatih
authors.initials: F
authors.lastname: Uzun
authors.forename: Aydın
authors.initials: A
authors.lastname: Yıldırım
authors.forename: Nevzat
authors.initials: N
authors.lastname: Uslu
authors.forename: Çağlar
authors.initials: Ç
authors.lastname: Çuhadaroğlu
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000473:pathology; D016280:Atrial Function, Right; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology*; D012720:Severity of Illness Index; D014463:Ultrasonography