PMID- 11834666
OWN - NLM
STAT- MEDLINE
DCOM- 20020322
LR  - 20220409
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 121
IP  - 2
DP  - 2002 Feb
TI  - The prognostic role of the ECG in primary pulmonary hypertension.
PG  - 513-8
AB  - BACKGROUND/RATIONALE: Doppler echocardiography and invasive hemodynamic 
      parameters reflective of right ventricular failure are associated with a poor 
      prognosis in patients with primary pulmonary hypertension (PPH). The aims of the 
      present study were to examine whether ECG features in patients with PPH are 
      associated with a decrease in survival, and to determine the value of the ECG in 
      risk stratification. METHODS/RESULTS: We analyzed the ECG, New York Heart 
      Association (NYHA) class, and hemodynamic parameters in 51 untreated patients 
      with PPH (88% women; mean age, 41.7 years; 79% NYHA classes III and IV) evaluated 
      between 1992 and 1998. Subsequent treatment included epoprostenol in 37 patients, 
      calcium channel blockers in 10 patients, epoprostenol and atrial septostomy in 2 
      patients, and lung transplant in 3 patients. As of 1999, 16 patients had died. 
      Based on Kaplan-Meier estimates, median survival was > 6.5 years and estimated 
      survival at 1 year, 3 years, and 5 years was 86%, 71%, and 57%, respectively. 
      Significant predictors of decreased survival by Cox regression analysis include 
      pulmonary vascular resistance (PVR; hazard ratio [HR], 1.11 per Wood unit), 
      cardiac index (HR, 0.22 per L/min/m(2)), p wave amplitude in lead II (HR, 3.06 
      per mm), p > or = 0.25 mV in lead II (HR, 2.77), qR in V(1) (HR, 3.55), and World 
      Health Organization criteria for right ventricular hypertrophy (HR, 4.26). After 
      controlling for PVR, the HRs attributable to the ECG criteria were only slightly 
      diminished. NYHA class and pulmonary artery pressures did not correlate with a 
      decrease in survival. CONCLUSIONS: ECG parameters reflective of physiologic and 
      anatomic abnormalities in the right ventricle are associated with decreased 
      survival in patients with PPH, and may be useful for deciding therapeutic choices 
      including the timing for lung transplantation listing.
FAU - Bossone, Eduardo
AU  - Bossone E
AD  - Division of Cardiology, Department of Internal Medicine, University of Michigan, 
      Ann Arbor, MI 48106-0363, USA.
FAU - Paciocco, Giuseppe
AU  - Paciocco G
FAU - Iarussi, Diana
AU  - Iarussi D
FAU - Agretto, Angelo
AU  - Agretto A
FAU - Iacono, Aldo
AU  - Iacono A
FAU - Gillespie, Brenda W
AU  - Gillespie BW
FAU - Rubenfire, Melvyn
AU  - Rubenfire M
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Calcium Channel Blockers)
RN  - DCR9Z582X0 (Epoprostenol)
SB  - IM
MH  - Adult
MH  - Calcium Channel Blockers/therapeutic use
MH  - *Echocardiography, Doppler
MH  - Epoprostenol/therapeutic use
MH  - Female
MH  - Heart Septum/surgery
MH  - Hemodynamics
MH  - Humans
MH  - Hypertension, Pulmonary/diagnostic imaging/*mortality/physiopathology/therapy
MH  - Lung Transplantation
MH  - Male
MH  - Prognosis
MH  - Survival Rate
MH  - Vascular Resistance
EDAT- 2002/02/09 10:00
MHDA- 2002/03/23 10:01
CRDT- 2002/02/09 10:00
PHST- 2002/02/09 10:00 [pubmed]
PHST- 2002/03/23 10:01 [medline]
PHST- 2002/02/09 10:00 [entrez]
AID - S0012-3692(16)35459-9 [pii]
AID - 10.1378/chest.121.2.513 [doi]
PST - ppublish
SO  - Chest. 2002 Feb;121(2):513-8. doi: 10.1378/chest.121.2.513.