المؤلفون: Balieva I; Hatter Institute for Cardiovascular Research in Africa, SAMRC Cape Heart Centre, IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; University of Groningen, Groningen, the Netherlands. Email: irinabalieva@gmail.com., Dzudie A; Hatter Institute for Cardiovascular Research in Africa, SAMRC Cape Heart Centre, IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Internal Medicine, Douala General Hospital, Douala, Cameroon; NIH Millennium Fogarty Chronic Disease Leadership Programme; Soweto Cardiovascular Research Heart Unit (SOCRU), Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa., Thienemann F; Hatter Institute for Cardiovascular Research in Africa, SAMRC Cape Heart Centre, IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Clinical Infectious Diseases Research Initiative, IDM, University of Cape Town; Integerafrica Research and Development, Cape Town; Wellcome Centre Infectious Diseases Research in Africa, Institue of Infectious Diseases and Molecular Medicine, Cape Town; and Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa., Mocumbi AO; Instituto Nacional de Saúde; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique., Karaye K; Department of Medicine, Bayero University, Kano, Nigeria., Sani MU; Hatter Institute for Cardiovascular Research in Africa, SAMRC Cape Heart Centre, IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Medicine, Bayero University, Kano, Nigeria., Ogah OS; Department of Medicine, University College Hospital, Ibadan; Ministry of Health, Umuahia, Nigeria., Voors AA; University of Groningen, Groningen, the Netherlands., Kengne AP; Hatter Institute for Cardiovascular Research in Africa, SAMRC Cape Heart Centre, IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Non-Communicable Diseases Unit, South African Medical Research Council, Cape Town, South Africa., Sliwa K; Hatter Institute for Cardiovascular Research in Africa, SAMRC Cape Heart Centre, IDM, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa; Soweto Cardiovascular Research Heart Unit (SOCRU),Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.

المصدر: Cardiovascular journal of Africa [Cardiovasc J Afr] 2017 Nov/Dec 23; Vol. 28 (6), pp. 370-376. Date of Electronic Publication: 2017 Oct 11.

نوع المنشور: Journal Article; Multicenter Study

بيانات الدورية: Publisher: Clinics Cardive Pub Country of Publication: South Africa NLM ID: 101313864 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1680-0745 (Electronic) Linking ISSN: 10159657 NLM ISO Abbreviation: Cardiovasc J Afr Subsets: MEDLINE

مواضيع طبية MeSH: Electrocardiography* , Heart Rate*, Arrhythmias, Cardiac/*diagnosis , Arrhythmias, Cardiac/*epidemiology , Heart Conduction System/*physiopathology , Hypertension, Pulmonary/*diagnosis , Hypertension, Pulmonary/*epidemiology, Action Potentials ; Adult ; Africa/epidemiology ; Arrhythmias, Cardiac/physiopathology ; Arterial Pressure ; Biomechanical Phenomena ; Case-Control Studies ; Female ; Humans ; Hypertension, Pulmonary/physiopathology ; Male ; Middle Aged ; Myocardial Contraction ; Predictive Value of Tests ; Prevalence ; Pulmonary Artery/physiopathology ; Registries ; Ventricular Function, Right

مستخلص: Background: Pulmonary hypertension (PH) is prevalent in Africa and is still often diagnosed only at an advanced stage, therefore it is associated with poor quality of life and survival rates. In resource-limited settings, we assessed the diagnostic utility of standard 12-lead electrocardiograms (ECG) to detect abnormalities indicating PH.
Methods: Sixty-five patients diagnosed with PH were compared with 285 heart disease-free subjects. The prevalence and diagnostic performance of ECG features indicative of PH and right heart strain were calculated.
Results: Compared to the control group, all abnormalities were more frequent in the PH cohort where no patient had a completely normal ECG. The most prevalent (cases vs control) ECG abnormalities were: pathological Q wave in at least two contiguous peripheral leads (47.7 vs 6.7%), left ventricular hypertrophy (38.5 vs 9.8%) and p-pulmonale (36.9 vs 20.7%) (all p < 0.05). The sensitivity of ECG criteria for right heart strain ranged between 6.2 and 47.7%, while specificity ranged between 79.3 and 100%. Negative predictive value ranged between 81.5 and 88.9% and positive predictive value between 25 and 100%. Positive predictive value was lowest (25%) for right bundle branch block and QRS rightaxis deviation (≥ 100°), and highest (100%) for QRS axis ≥ +100° combined with R/S ratio in V1 ≥ 1 or R in V1 > 7 mm.
Conclusion: When present, signs of PH on ECG strongly indicated disease, but a normal ECG cannot rule out disease. ECG patterns focusing on the R and S amplitude in V1 and right-axis deviation had good specificity and negative predictive values for PH, and warrant further investigation with echocardiography.