Assessment of right ventricular overload in patients with chronic pulmonary disease by 12-lead electrocardiography, vectorcardiography, and body surface electrocardiographic mapping.

Twenty-eight patients with chronic pulmonary diseases were examined with standard 12-lead electrocardiogram (ECG), vectorcardiogram (VCG), and body surface ECG mapping (MAP). The electrocardiographic findings were compared with results of 99 mTc radionuclide right ventriculography or T1-201 myocardial scintigraphy. In a stepwise multiple regression analysis between the electrocardiographic parameters and right ventricular ejection fraction, only the amplitude of the negative P wave in V2 (r = 0.69), the posterior force of P loop in VCG (r = 0.71), and the size of -2SD area at 50 msec QRS potential departure map (r = 0.55) were selected as the parameters in standard ECG, VCG, and MAP, respectively. On the radionuclide ventriculography and myocardial scintigraphy, 14 patients were judged to have right ventricular overload. The criteria by VCG, and MAP had better sensitivity and specificity for right ventricle overload than those by 12-lead ECG. VCG criteria of Chou et al had sensitivity of 93% and specificity of 71%. MAP criteria, departure index of F3 or F4 less than or equal to -2, had sensitivity of 86% and specificity of 79%. The electrocardiographic findings by standard 12-lead ECG, VCG and body surface ECG mapping are useful parameters for the noninvasive detection of right ventricular overload in patients with chronic pulmonary diseases.