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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 2, March/April 2020
AFRICA
75
An easy method for monitoring patients with pulmonary
hypertension: P-wave dispersion
Arif Oguzhan Cimen, Samim Emet
Abstract
Background:
Pulmonary arterial hypertension (PAH) is
a haemodynamic and pathophysiological condition with
restricted flow through the pulmonary arterial circulation. In
pulmonary hypertension, right ventricular hypertrophy and
diastolic dysfunction can lead to an increase in atrial strain,
fibrosis and dilation, which cause inhomogeneous atrial
conduction. Interlead variation in P-wave duration is called
P-wave dispersion (PwD), which is an electrocardiographic
parameter that can be used to predict atrial arrhythmias. Our
aim was to investigate the relationship between PwD, func-
tional capacity, and invasive and non-invasive haemodynamic
parameters of patients diagnosed with PAH.
Methods:
Between 2015 and 2017 we enrolled 33 patients
admitted to our in-patient clinic and diagnosed with PAH,
and 32 healthy individuals for the control group. Details
of these patients at the time of diagnosis were analysed,
including gender, age, physical examination, electrocardio-
gram (ECG), echocardiography, six-minute walk test distance
(6MWD), haemodynamic parameters and blood tests for
biochemical markers that are correlated with clinical severity.
Statistical analyses were performed using SPSS version 20.0
(SPSS Inc, Chicago, Illinois, USA). Statistical significance
was taken as
p
<
0.05.
Results:
In the forward stepwise multiple linear regression
analysis, PwD and mean pulmonary artery pressure deter-
mined by right heart catheterisation were independently
related to the functional capacity tested by the 6MWD (
p
<
0.02
and
p
<
0.01, respectively).
Conclusion:
PwD can easily be calculated from a surface ECG
to indirectly estimate the functional status and prognosis of
the patient with PAH.
Keywords:
P-wave dispersion, functional status, haemodynamic
parameters, pulmonary artery hypertension
Submitted 19/8/19, accepted 3/9/19
Published online
Cardiovasc J Afr
2019;
31
: 75–80
www.cvja.co.zaDOI: 10.5830/CVJA-2019-053
Pulmonary arterial hypertension (PAH) is a haemodynamic and
pathophysiological condition with restricted flow through the
pulmonary arterial circulation, resulting in increased pulmonary
vascular resistance (PVR) and ultimately, right-sided heart
failure (HF).
1
Pre-capillary PAH is defined as an increase in
mean pulmonary arterial pressure (mPAP)
≥
25 mmHg and
PVR
>
3.0 Wood units (WU) without significant elevation of
the pulmonary capillary wedge pressure (PCWP) (PCWP
≤
15
mmHg) at rest as assessed by right heart catheterisation (RHC).
2
Right ventricular (RV) function is a major determinant of
functional capacity and prognosis in PAH.
3
In PAH, RV hypertrophy and diastolic dysfunction can lead
to an increase in atrial strain, fibrosis and dilation. This is called
right heart reverse remodelling (RHRR). RHRR and RV failure
are major determinants of symptoms and reduced survival time in
PAH.
4
These changes result in inhomogeneous atrial conduction.
Heterogeneity in atrial conduction can be seen as a variation
in P-wave duration between differently orientated surface
electrocardiogram (ECG) leads. Interlead variation in P-wave
duration is called P-wave dispersion (PwD)
5
and is an easily
calculated ECG parameter that can be used to predict increased
atrial strain caused by RHRR linked to atrial arrhythmias. This
can indicate a poor prognosis in PAH patients.
5
Our aim was to investigate the relationship between PwD,
functional capacity, and invasive andnon-invasive haemodynamic
parameters of patients diagnosed with PAH.
Methods
We enrolled 33 patients (26 females and seven males, mean age
of 48.6
±
2.6 years), who were admitted to our in-patient clinic
between 2015 and 2017 and diagnosed with PAH according
to the European Society of Cardiology/European Respiratory
Society (ESC/ERS) guidelines for the diagnosis of PAH,
2
and
32 healthy individuals for the control group. Written informed
consent was obtained. The study complied with the Declaration
of Helsinki and the local ethics committee approved trial
protocol (number: 78, date: 12.01.2015 and 03).
The inclusion criteria were:
•
patients diagnosed with group 1 PAH according to the ESC/
ERS guidelines, including idiopathic PAH
•
patients diagnosed with group 3 PAH according to the ESC/
ERS guidelines, including lung diseases and/or hypoxia
•
patients diagnosed with group 4 PAH according to the ESC/
ERS guidelines, including chronic thromboembolic pulmo-
nary hypertension and other pulmonary artery obstructions
•
patients diagnosed with group 5 PAH according to the
ESC/ERS guidelines, including unclear and/or multifactorial
mechanisms.
The exclusion criteria were:
•
patients with PAH due to left-sided heart diseases (PAH
group 2 patients)
•
patients with coincident cardiac diseases (hypertension, coro-
nary artery disease, diabetes, renal failure), left bundle branch
block, significant arrhythmias, including atrial fibrillation,
Department of Cardiology, Medical Faculty, Bahcesehir
University, Istanbul, Turkey
Arif Oguzhan Cimen, MD
Department of Cardiology, Medical Faculty, Istanbul
University, Istanbul, Turkey
Samim Emet, MD,
samim.emet@istanbul.edu.tr