Prediction of Pulmonary Arterial Hypertension in Chronic Obstructive Lung Disease from Three-Dimensional Vectorcardiographic Parameters.

ABSTRACT

AIM: The objective of our study was to assess diagnostic value of three-dimensional (3D) vectorcardiographic (VCG) parameters in detecting pulmonary arterial hypertension (PAH) in chronic obstructive lung disease (COLD) with and without right ventricular hypertrophy (RVH). METHODS: The study group of 62 patients with COPD was stratified on the basis of color Doppler echocardiographic findings into three subgroups non-PAH (n = 23), PAH without RVH (n = 22), and PAH with RVH (n = 17). Pairwise differences between the subgroups were evaluated by one-way analysis of variance, and Pearson correlation analysis was used to evaluate the significance of the correlations between pulmonary arterial systolic pressure (PASP) and various VCG parameters. RESULTS: The azimuth of the QRS vector decreased from -24° in the non-PAH group to -62° in PAH without RVH and to -140° in PAH with RVH (P < 0.01 for pairwise differences between all three groups). Similar significant decrease was observed for the azimuth of the ventricular gradient (VG) vector. Spatial QRS/T angle increased from 69° in the non-PAH group to 115° in PAH without RVH (P < 0.01). In the PAH group with RVH, QRS/T angle was 94° (P < 0.05 for difference from the non-PAH group). There was a significant correlation between PASP and QRS/T angle (r = 0.89, P < 0.05) and between PASP and the azimuth of the VG vector (r = 0.86, P < 0.05). PASP increase from linear regression model was 0.8 mmHg for a QRS/T angle increase by 10° and 1.3 mmHg for each 10° increase in the azimuth of the VG vector. CONCLUSION: 3DVCG parameters are potentially useful for predicting PASP in COLD patients, and possibly also for differentiation between COLD patients with PAH and RVH from those without RVH.