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[Electrocardiographic findings in pulmonary arterial hypertension in children]
J A Marín1, A Buendía, D Zavaleta
1Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Insights
Electrocardiogram changes can help suspect pulmonary hypertension (PH) in children, especially the primary or essential type (PPH). Specific findings like right axis deviation and ST-T changes show promise in identifying PPH with elevated resistance.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Diagnostic Imaging
Context:
- Pulmonary hypertension (PH) poses significant cardiovascular risks, particularly primary or essential pulmonary hypertension (PPH).
- Accurate diagnosis of PH often requires invasive methods, while non-invasive electrocardiogram (ECG) approaches have historically yielded suboptimal results due to inadequate criteria.
- Pediatric PH, especially PPH and PH associated with ventricular septal defects (VSD), presents unique diagnostic challenges.
Purpose:
- To evaluate the diagnostic utility of electrocardiographic (ECG) findings in suspecting pulmonary hypertension (PH) in children, differentiating between primary or essential pulmonary hypertension (PPH) and PH due to interventricular septal defect (VSD).
- To compare ECG characteristics and hemodynamic data between children with PPH, children with VSD-associated PH, and healthy controls.
- To assess the sensitivity, specificity, and predictive value of specific ECG changes for identifying PPH with elevated pulmonary vascular resistance.
Summary:
- Hemodynamic and ECG data from 12 children with PPH, 10 with VSD-associated PH, and 53 controls were analyzed.
- PPH patients exhibited significantly higher pulmonary vascular resistance compared to VSD patients.
- Distinct ECG patterns, including right axis deviation, peaked P waves, prolonged ventricular activation time, and prominent ST-T changes, were observed in PPH patients, distinguishing them from VSD patients and controls (p < 0.01).
Impact:
- The identified ECG changes demonstrated good sensitivity (80%) and specificity (81%) in suspecting PH with pulmonary vascular resistance exceeding 10 u/m2, with a 75% predictive value (p < 0.02).
- These ECG findings, specifically P wave and ST-T abnormalities, offer a valuable non-invasive tool for suspecting PPH with elevated resistance, potentially serving as an alternative to right ventricular hypertrophy voltage criteria.
- This research enhances the non-invasive diagnostic capabilities for pediatric pulmonary hypertension, guiding further investigation and management.
Abstract:
Pulmonary hypertension (PH) induces high risk of cardiovascular morbidity and mortality, mainly in the primary or essential type. Invasive studies are needed to confirm the diagnosis; among the non- invasive approach, the electrocardiogram has been used to suspect such entity with poor results due to inadequate diagnostic criteria. Twelve children with pulmonary hypertension of the essential type (PPH) and ten children with PH due to interventricular septal defect (VSD) were studied haemodynamically and electrocardiographically and compared to electrocardiographic data of 53 normal children. PPH showed higher resistances than VSD (17.2 +/- 1.9 vs 6 +/- 0.6 u/m2 p less than 0.01) with the same pressure level (99.5 +/- 10.3 vs 101.5 +/- 4.8 mmHg). Right axis deviation, peaked P wave, increased ventricular activation time and prominent ST-T changes were seen in PPH patients whereas in VSD the electrical axis was within normal limits, without P wave changes and in some cases, less conspicuous ST-T abnormalities were observed (p less than 0.01). Such changes showed good sensitivity (80%) and specificity (81%) to suspect PH with resistances higher than 10 u/m2 with a predictive value of 75% (p less than 0.02). P wave and ST-T changes could be of use to suspect PPH with elevated resistances instead of right ventricular hypertrophy voltage criteria.