Author + information
- Matthew S. Tong,
- Jose R. Po,
- Talha Meeran,
- Mark Doyle,
- Geetha Rayarao and
- Robert Biederman
Background: RV hypertrophy (RVH) is widely prevalent in the pulmonary hypertension (PH) population. ECG has been the initial screening tool for the RV. The role of CMR has become the primary PH assessment modality due to its high temporal/spatial resolution and high reproducibility. Limited data on RVH is available as it compares to the ECG, yet the latter is ubiquitous. We aim to correlate the accuracy of ECG criteria for RVH 2009 AHA Recommendations for Standardization and Interpretation of the ECG with CMR quantitative mass measurements based on the consensus statement of normal values for CMR in adults.
Methods: A retrospective chart review was performed with consecutive patients in the PH clinic at our institution. Baseline characteristics, PH WHO group classifications, ECGs, and CMR data regarding RV mass (RVM) and volumes were extracted for analysis. ECG diagnosis of RVH followed the 2009 AHA recommendations. Statistical analyses were performed with RVM, RV mass index (RVMI), and RVEDVI against all ECG-RVH diagnoses.
Results: In the cohort of 111, 56% (n=62) were WHO group I PAH, and 37% (n=23) had RVH by RVMI, and 39% (n=24) by ECG. Regarding the other non-WHO group I PH patients (n=49), 31% (n=15) had RVH by RVMI, and 22% (n=11) by ECG. In entire cohort, RVH-ECG had a sensitivity of 50%, specificity of 78% and an accuracy of 68% when compared to RVMI. The ECG was less accurate when comparing only PAH patients (sensitivity = 52%, specificity = 69%, accuracy = 63%). When RV dilation by CMR was added to the ECG RVH interpretation, sensitivity was lower (47%), but the specificity was higher (84%), with the accuracy similar (66%). In light of potential correlation of mass and volume related ECG vector modulations, an analysis was performed for the accuracy of ECG-RVH with RV dilation and normal RVMI by CMR. There were 6 patients (5%) that had RV dilation alone without abnormal RVMI, of which 4 patients had ECG-RVH (67%).
Conclusions: Overall, ECG accuracy for RVH is poorly accurate when compared to CMR RV mass assessment while the addition of CMR RV dilation criteria made the ECG more specific, suggesting perhaps the vector forces from a larger, not necessarily thicker chamber is in part, the explanation of ECG-RVH.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Advances in Pulmonary Arterial Hypertension
Abstract Category: 35. Pulmonary Hypertension and Pulmonary Thrombo-embolic Disease
Presentation Number: 1269-005
- 2017 American College of Cardiology Foundation