Author + information
- John Allison,
- Francisco Macedo,
- Ihab Hamzeh and
- Yochai Birnbaum
Background: Previous attempts to validate ECG criteria for right atrial (RA) enlargement (RAE) have been limited by sample sizes and lack of accepted standards for measuring RA size. New guidelines have recommended that RA volume be used to determine RA size. Since these guidelines were released, no studies have been published that correlate RAE by ECG, called P pulmonale, to RA size by echocardiography using the new standards.
Methods: We identified patients from the pulmonary hypertension (PHT) clinic that had an echocardiogram and ECG done at most 30 days apart. We defined increased P wave amplitude as ≥ 2mm in lead II and ≥ 1mm in lead V1. The RA determined to be enlarged if the RA volume index was ≥39 mL/m2 for men and ≥33 mL/m2 for women. Patients were stratified into four groups: those with P II ≥2mm, those with P V1 ≥1mm, those that met both criteria, and those that met neither. Right atrial volumes were then compared.
Results: Sixty-three patients were included in the study (7 men, 56 women). Three men and 36 women had an ECG that met criteria for P pulmonale. Five men and 28 women had an enlarged RA on echocardiogram. Sixty-nine percent of ECGs that met criteria for RAE were associated with increased RA volume by echocardiogram. The specificity of each ECG criteria for P pulmonale at detecting RAE was 100% for men and at least 70% for women. The sensitivity of each criterion was much lower, 25-67% for men and 21-48% for women. The correlation of P wave amplitude in leads II and V1 and RA volume index was not statistically significant for any of the ECG criteria for P pulmonale.
Conclusions: In patients with PHT, the specificity of P pulmonale for detecting RAE is high, but the sensitivity is relatively low. These results suggest that in PHT, P pulmonale can be used to confirm that the RA is enlarged, but it is not a reliable test for diagnosing RAE.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Imaging Pulmonary Vascular Disease Plus the Impact of Congenital Heart Disease
Abstract Category: 35. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease
Presentation Number: 1100-003
- 2017 American College of Cardiology Foundation