Key result
The R/S ratio in the synthesized V5R lead was a strong predictor of pulmonary hypertension (AUC 0.823), with a ratio >0.42 providing 73% sensitivity and 87% specificity, improving upon conventional 12-lead ECG criteria.
Why the study?
Does a synthesized right-sided chest ECG improve the diagnostic accuracy for detecting pulmonary hypertension compared to standard 12-lead ECG criteria?
Case-Control (n=60)
No
Does a synthesized right-sided chest ECG improve the diagnostic accuracy for detecting pulmonary hypertension compared to standard 12-lead ECG criteria?
Synthesized right-sided chest ECGs derived from standard 12-lead ECGs significantly improve the sensitivity of detecting pulmonary hypertension without requiring additional lead placement.
Answers are grounded in this paper and cite their sources.
Syn-ECG criteria may improve PH detection sensitivity on routine ECGs; leaves open prospective validation before clinical adoption.
BACKGROUND: Current standard 12-lead electrocardiogram (ECG) criteria for diagnosing pulmonary hypertension (PH) have a low sensitivity. Although the right-sided chest ECG (V3R-V5R) increases the diagnostic accuracy, these additional leads are not routinely recorded. The aim of the present study was to assess the usefulness of the synthesized right-sided chest ECG (Syn-ECG), generated from 12-lead ECG information, in the detection and evaluation of PH. PATIENTS AND METHODS: The Syn-ECG waveforms in 30 patients with PH, defined as an estimated pulmonary arterial systolic pressure (PASP) >35 mmHg, were compared to those in 30 age- and gender-matched normal subjects. RESULTS: The R wave amplitude and R/S ratio in the Syn-ECGs were significantly (P<0.01) greater in patients with PH than in the controls. The R wave amplitude in the Syn-ECGs exhibited a significant and better correlation (correlation coefficient 0.513-0.596, P<0.001) with the PASP than lead V1 (correlation coefficient 0.375, P=0.02). A receiver-operating characteristic curve analysis showed that the R wave amplitude (AUC 0.802, P<0.001) and R/S ratio (AUC 0.823, P<0.001) in the synthesized V5R was a good predictor of PH. New criteria, including 1) an R in V5R>0.12 mV, and 2) R/S ratio in V5R>0.42, had an improved sensitivity (0.63 and 0.73, respectively) and comparable specificity (0.93 and 0.87, respectively) to the conventional criteria (sensitivity 0.10-0.43, specificity 0.90-1.00). CONCLUSION: The diagnostic criteria derived from the Syn-ECG provided better diagnostic accuracy than the known conventional criteria from the standard 12-lead ECG. This technique described in the present study may be useful for diagnosing and evaluating PH.
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Nakatsuji et al. (2015) conducted a case-control in Pulmonary hypertension (n=60). Synthesized right-sided chest ECG vs. Standard 12-lead ECG was evaluated on Prediction of pulmonary hypertension using R/S ratio in synthesized V5R (AUC 0.823, 95% CI 0.712-0.934, p=<0.001). The R/S ratio in the synthesized V5R lead was a strong predictor of pulmonary hypertension (AUC 0.823), with a ratio >0.42 providing 73% sensitivity and 87% specificity, improving upon conventional 12-lead ECG criteria.
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