title: Electrocardiographic differences between COPD patients evaluated for lung transplantation with and without pulmonary hypertension.
abstract: BACKGROUND
  Pulmonary hypertension (PH) is an indicator of poor prognosis in COPD patients; particularly in those with mean pulmonary artery pressure ≥ 40 mm Hg. Electrocardiography (ECG) might be useful for screening of this condition.
  
  
  METHODS
  Retrospective study of COPD patients evaluated for lung transplantation in whom we analyzed the 12-lead ECG performed closest to the time of right heart catheterization.
  
  
  RESULTS
  We included 142 patients. PH was present in 90 patients (63%) and 16 (11%) had a mean PAP ≥ 40 mmHg. The PR interval was longer in PH patients (151 (29) versus 139 (22) ms, p = 0.01) and T wave axis had a left shift (56.9 (32) versus 68.7 (19) degrees, p = 0.006). PR interval was longer (178.5 (35) versus 142.2 (23) ms, p = 0.001), T wave axis had a leftward deflection (63.6 (24) versus 42.8 (46) degrees, p = 0.005) and S wave in lead I was larger (0.19 (0.13) versus 0.12 (0.12) mV, p = 0.03) in patients with mean PAP ≥ 40 mmHg. A PR interval > 137 ms and S wave in DI > 0.02 mV had a sensitivity of 100% and a specificity of 59.5% to identify COPD patients with a mean PAP ≥ 40 mmHg.
  
  
  CONCLUSIONS
  There are significant ECG differences between advanced COPD patients with and without PH; however the ECG is an inadequate tool to differentiate between the groups. A prolonged PR interval suggests the presence of severe PH.
authors.affiliation: Department of Pulmonary, Allergy and Critical Care Medicine. Respiratory Institute , Cleveland Clinic, Cleveland, OH , USA.
authors.forename: Laith
authors.initials: L
authors.lastname: Alkukhun
authors.forename: Manfred
authors.initials: M
authors.lastname: Baumgartner
authors.forename: Marie
authors.initials: M
authors.lastname: Budev
authors.forename: Raed A
authors.initials: RA
authors.lastname: Dweik
authors.forename: Adriano R
authors.initials: AR
authors.lastname: Tonelli
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D062186:Arterial Pressure; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers
keywords: Chronic obstructive pulmonary disease; electrocardiogram; pulmonary hypertension