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The Anatolian Journal of Cardiology Role of electrocardiographic changes in discriminating acute or chronic right ventricular pressure overload [Anatol J Cardiol]
Anatol J Cardiol. 2013; 13(4): 344-349 | DOI: 10.5152/akd.2013.101  

Role of electrocardiographic changes in discriminating acute or chronic right ventricular pressure overload

Mehmet Mustafa Can1, Olcay Özveren2, Murat Biteker3, Cihan Şengül4, Ömer Uz1, Zafer Işılak6, Ata Kırılmaz1
1Department of Cardiology, GATA Haydarpaşa Education and Research Hospital, İstanbul-Turkey
2Department of Cardiology, Faculty of Medicine, Yeditepe University, İstanbul-Turkey
3Clinic of Cardiology, Haydarpaşa Numune Hospital, İstanbul-Turkey
4Clinic of Cardiology, Çamlıca Alman Hospital, İstanbul-Turkey
5Department of Cardiology, GATA Haydarpaşa Education and Research Hospital, İstanbul-Turkey
6Department of Cardiology, Gülhane Military Medical Academy, Haydarpaşa Hospital, İstanbul-Turkey
7Department of Cardiology, GATA Haydarpaşa Education and Research Hospital, İstanbul-Turkey

Objective: Pulmonary embolism (PE) and severe pulmonary stenosis (PS) are two distinct conditions accompanied by increased pressure load of the right ventricle (RV). Despite major advances in our understanding of the mechanisms of RV adaptation to the increased pressure, substantial gaps in our knowledge remain unsettled. One of much less known aspect of pressure overload of RV is its impact on electrocardiographic (ECG) changes. In this study, we aimed to study whether acute and chronic RV overload are accompanied by different ECG patterns. Methods: Thirty-eight patients with PE underwent ECG monitoring were compared with 20 matched patients with PS in this observational retrospective study. ECG abnormalities suggestive of RV overload were recorded and analyzed in both groups. Logistic regression analysis was used to define the predictors of chronic RV overload. Results: Among the ECG changes studied, premature atrial contraction (OR-12.2, 95% CI, 1.3-107, p=0.008), right axis deviation (OR-20.4, 95% CI 4.2-98, p<0.001), indeterminate axis (OR-0.11, 95% CI 0.02-0.44, p=0.001 0.11), incomplete right bundle branch block (OR-4.2, 95% CI, 1.1-15.4, p=0.02), late R in aVR (OR-8.4, 95% CI 2.1-33.2, p=0.001), qR in V1 lead (OR-8.3, 95% CI 1.2-74.8, p=0.03) were found to be the independent predictors of chronic RV pressure overload. Conclusion: Our data indicate that the ECG changes that attributed to the acute RV pressure loading states may be more prevalent in chronic RV overload as compared with acute RV overload.

Keywords: Right ventricular pressure load, electrocardiography, disease process, regression analysis


Mehmet Mustafa Can, Olcay Özveren, Murat Biteker, Cihan Şengül, Ömer Uz, Zafer Işılak, Ata Kırılmaz. Role of electrocardiographic changes in discriminating acute or chronic right ventricular pressure overload. Anatol J Cardiol. 2013; 13(4): 344-349


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