|
Dr Ahearn, do you agree with the ACCP recommendation
that, in patients with a suspicion of PAH, electrocardiography
should be performed to screen for cardiac anatomic and
arrhythmic problems though it lacks sensitivity as a screening
tool for PAH, but contributes prognostic information in
patients with known PAH?
|
 Gregory
S. Ahearn, MD
Pulmonary Fellow
Division of Pulmonary and Critical Care Medicine
Duke University Medical Center
Durham, North Carolina
|
Electrocardiography is a noninvasive, widely available
test that should be performed in all patients with cardiovascular
complaints. In patients with established PAH, electrocardiography
has a limited role in monitoring patients except for acute
arrhythmic and ischemic events. In patients undergoing
evaluation of their symptoms, however, it is important
to recognize the limitations of the test. In our investigation
of 61 patients with significant PAH, 8 (13%) had normal
findings on electrocardiography, though these patients
tended to have less severe
disease. Other common electrocardiographic indicators
correlated poorly with hemodynamic and clinical parameters.
Thus, the ACCP recommendation that electrocardiography
is inadequate as a screening tool is correct.
The most definitive prognostic information available
on electrocardiography in PAH comes from a study by Bossone
and colleagues in which they retrospectively analyzed
the initial electrocardiographic findings in 51 untreated
patients with PAH.1 Despite
the limitations of this type of study design, these data
suggest that electrocardiographic findings consistent
with right ventricular hypertrophy bode a worse prognosis.
No meaningful data are available on the use of electrocardiography
to monitor response to treatment.
In summary, I agree with the ACCP recommendations on
the use of electrocardiography. A key point is that electrocardiography
is an inadequate tool to exclude PAH. Electrocardiographic
criteria for right ventricular hypertrophy can be of prognostic
significance, but these probably do not add much value
to other more robust predictors of mortality (for example,
hemodynamic values and exercise capacity). There is no
established role for electrocardiography in monitoring
PAH therapy.
Reference
1.Bossone E, Paciocco G, Iarussi
D, Agretto A, Iacono A, Gillespie BW,
Rubenfire M. The prognostic role of the ECG in primary
pulmonary
hypertension. Chest. 2002;121(2):513-8.
|
