A 3-point composite ECG pattern demonstrated 93% specificity and 91% positive predictive value for identifying markedly elevated pulmonary vascular resistance (>5 WU) in pulmonary hypertension.
Observational (n=95)
Do standard 12-lead ECG parameters correlate with invasive hemodynamic severity in patients with pulmonary hypertension?
A composite ECG pattern combining prolonged QTc, QRS > 90 ms, and rightward R-axis > 90° provides excellent specificity for identifying markedly elevated pulmonary vascular resistance in patients with pulmonary hypertension.
Abstract Introduction Invasive hemodynamic assessment by right heart catheterization (RHC) remains the gold standard for diagnosing pulmonary hypertension (PH) and determining disease severity. The 12-lead electrocardiogram (ECG) is widely available, inexpensive, and may provide complementary physiologic information. However, few studies have directly compared ECG-derived parameters with same-day invasive hemodynamic data. This study evaluated the association between standard ECG findings and invasive hemodynamics in patients with PH. Methods We performed a retrospective analysis of patients with confirmed PH who underwent same-day RHC and 12-lead electrocardiography. Standard ECG parameters—including PR interval, QRS duration, QTc, RS time, and frontal plane axes—were extracted from digital tracings. Hemodynamic variables included right atrial pressure (RAP), mean pulmonary arterial pressure (mPAP), pulmonary arterial wedge pressure (PAWP), cardiac output (CO), cardiac index (CI), and pulmonary vascular resistance (PVR). Results The cohort included 95 patients (mean age 60 ± 14 years, 68% female). PR interval correlated positively with RAP (R = 0.22, p = 0.02) and PVR (R = 0.22, p = 0.03), and negatively with CI (R = −0.20, p = 0.02). QTc correlated with higher PVR (R = 0.31, p = 0.003) and lower CI (R = −0.38, p 0.001). QRS duration and RS time showed no significant correlations. Of the frontal plane axes, only R-axis correlated with PVR (R = 0.24, p = 0.02). The 3-point composite ECG pattern (QTc 450 ms, QRS 90 ms, R-axis 90°) demonstrated 93% specificity, 29% sensitivity, positive predictive value of 91%, and negative predictive value of 35% for identifying markedly elevated PVR (5 WU). Composite-positive patients had significantly higher PVR (8.9 vs 5.9 WU, p = 0.03) and mPAP (49.5 vs 42.0 mmHg, p = 0.004), lower CI (2.19 vs 2.53 L/min/m², p = 0.04). Functional and biomarker assessments paralleled these hemodynamic differences: 6-minute walk distance was reduced (240 m vs 290 m, p = 0.04), and NT-proBNP levels were markedly higher (3015 pg/mL vs 1139 pg/mL, p = 0.03). Conclusion ECG parameters, particularly prolonged QTc, rightward R-axis, and PR interval prolongation, modestly reflect invasive hemodynamic severity in PH. A composite ECG pattern combining these abnormalities demonstrates excellent specificity for identifying patients with markedly elevated PVR, suggesting potential value as a non-invasive screening tool to identify those with severe pulmonary vascular load. This abstract is funded by: none
Shafique et al. (Fri,) conducted a observational in Pulmonary hypertension (PH) (n=95). 12-lead electrocardiogram (ECG) vs. Right heart catheterization (RHC) was evaluated on Association between standard ECG findings and invasive hemodynamics. A 3-point composite ECG pattern demonstrated 93% specificity and 91% positive predictive value for identifying markedly elevated pulmonary vascular resistance (>5 WU) in pulmonary hypertension.