-Original-

Detection and Evaluation of Pulmonary Hypertension by a Synthesized Right-Sided Chest Electrocardiogram

Ayano Nakatsuji, Yasushi Miyauchi, Yu-ki Iwasaki, Ippei Tsuboi, Hiroshi Hayashi, Shunsuke Uetake, Kenta Takahashi, Kenji Yodogawa, Meiso Hayashi and Wataru Shimizu

Department of Cardiovascular Medicine, Nippon Medical School

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.

J Nippon Med Sch 2015; 82: 136-145

Keywords
vectorcardiography, synthesized electrocardiogram, right ventricular hypertrophy, criteria, diagnostic accuracy

Correspondence to
Yasushi Miyauchi, MD, Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
miyauchi@nms.ac.jp

Received, February 25, 2015
Accepted, April 8, 2015