title: Detection and Evaluation of Pulmonary Hypertension by a Synthesized Right-Sided Chest Electrocardiogram.
abstract: BACKGROUND
  Current standard 12-lead electrocardiogram (ECG) criteria for diagnosing pulmonary hypertension (PH) have a low sensitivity. Although the right-sided chest ECG (V3R-V5R) increases the diagnostic accuracy, these additional leads are not routinely recorded. The aim of the present study was to assess the usefulness of the synthesized right-sided chest ECG (Syn-ECG), generated from 12-lead ECG information, in the detection and evaluation of PH.
  
  
  METHODS
  The Syn-ECG waveforms in 30 patients with PH, defined as an estimated pulmonary arterial systolic pressure (PASP) >35 mmHg, were compared to those in 30 age- and gender-matched normal subjects.
  
  
  RESULTS
  The R wave amplitude and R/S ratio in the Syn-ECGs were significantly (P<0.01) greater in patients with PH than in the controls. The R wave amplitude in the Syn-ECGs exhibited a significant and better correlation (correlation coefficient 0.513-0.596, P<0.001) with the PASP than lead V1 (correlation coefficient 0.375, P=0.02). A receiver-operating characteristic curve analysis showed that the R wave amplitude (AUC 0.802, P<0.001) and R/S ratio (AUC 0.823, P<0.001) in the synthesized V5R was a good predictor of PH. New criteria, including 1) an R in V5R>0.12 mV, and 2) R/S ratio in V5R>0.42, had an improved sensitivity (0.63 and 0.73, respectively) and comparable specificity (0.93 and 0.87, respectively) to the conventional criteria (sensitivity 0.10-0.43, specificity 0.90-1.00).
  
  
  CONCLUSIONS
  The diagnostic criteria derived from the Syn-ECG provided better diagnostic accuracy than the known conventional criteria from the standard 12-lead ECG. This technique described in the present study may be useful for diagnosing and evaluating PH.
authors.affiliation: Department of Cardiovascular Medicine, Nippon Medical School.
authors.forename: Ayano
authors.initials: A
authors.lastname: Nakatsuji
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyauchi
authors.forename: Yu-ki
authors.initials: YK
authors.lastname: Iwasaki
authors.forename: Ippei
authors.initials: I
authors.lastname: Tsuboi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hayashi
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Uetake
authors.forename: Kenta
authors.initials: K
authors.lastname: Takahashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Yodogawa
authors.forename: Meiso
authors.initials: M
authors.lastname: Hayashi
authors.forename: Wataru
authors.initials: W
authors.lastname: Shimizu
mesh_terms: D001794:Blood Pressure; D016022:Case-Control Studies; D004562:Electrocardiography / Q000379:methods*; D004566:Electrodes; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013909:Thorax / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D058067:Wavelet Analysis