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Article

Extended Precordial T Wave Inversions Are Associated with Right Ventricular Enlargement and Poor Prognosis in Pulmonary Hypertension

1
Pulmonary Circulation Centre, Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Krakow, 31-202 Krakow, Poland
2
Students’ Scientific Group of Pulmonary Circulation and Thromboembolic Diseases, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Kraków, Poland
3
Department of Cardiac and Vascular Diseases, Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital in Krakow, 31-202 Krakow, Poland
*
Author to whom correspondence should be addressed.
Academic Editor: Davide Chiumello
J. Clin. Med. 2021, 10(10), 2147; https://doi.org/10.3390/jcm10102147
Received: 15 April 2021 / Revised: 5 May 2021 / Accepted: 10 May 2021 / Published: 16 May 2021
In pulmonary hypertension (PH), T wave inversions (TWI) are typically observed in precordial leads V1–V3 but can also extend further to the left-sided leads. To date, the cause and prognostic significance of this extension have not yet been assessed. Therefore, we aimed to assess the relationship between heart morphology and precordial TWI range, and the role of TWI in monitoring treatment efficacy and predicting survival. We retrospectively analyzed patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) treated in a reference pulmonary hypertension center. Patients were enrolled if they had a cardiac magnetic resonance (cMR) and 12-lead surface ECG performed at the time of assessment. They were followed from October 2008 until March 2021. We enrolled 77 patients with PAH and 56 patients with inoperable CTEPH. They were followed for a mean of 51 ± 33.5 months, and during this time 47 patients died (35.3%). Precordial TWI in V1–V6 were present in 42 (31.6%) patients, while no precordial TWI were observed only in 9 (6.8%) patients. The precordial TWI range correlated with markers of PH severity, including right ventricle to left ventricle volume RVEDVLVEDV (R = 0.76, p < 0.0001). The presence of TWI in consecutive leads from V1 to at least V5 predicted severe RV dilatation (RVEDVLVEDV ≥ 2.3) with a sensitivity of 88.9% and specificity of 84.1% (AUC of 0.90, 95% CI = 0.83–0.94, p < 0.0001). Presence of TWI from V1 to at least V5 was also a predictor of mortality in Kaplan–Meier estimation (p = 0.02). Presence of TWI from V1 to at least V5 had a specificity of 64.3%, sensitivity of 58.1%, negative predictive value of 75%, and positive predictive value of 45.5% as a mortality predictor. In patients showing a reduction in TWI range of at least one lead after treatment compared with patients without this reduction, we observed a significant improvement in RV-EDV and RVEDVLVEDV. We concluded that the extension of TWI to left-sided precordial leads reflects significant pathological alterations in heart geometry represented by an increase in RV/LV volume and predicts poor survival in patients with PAH and CTEPH. Additionally, we found that analysis of precordial TWI range can be used to monitor the effectiveness of hemodynamic response to treatment of pulmonary hypertension. View Full-Text
Keywords: pulmonary hypertension; electrocardiography; T wave inversion; right ventricle dilatation; chronic thromboembolic pulmonary hypertension; pulmonary arterial hypertension pulmonary hypertension; electrocardiography; T wave inversion; right ventricle dilatation; chronic thromboembolic pulmonary hypertension; pulmonary arterial hypertension
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MDPI and ACS Style

Waligóra, M.; Gliniak, M.; Bylica, J.; Pasieka, P.; Łączak, P.; Podolec, P.; Kopeć, G. Extended Precordial T Wave Inversions Are Associated with Right Ventricular Enlargement and Poor Prognosis in Pulmonary Hypertension. J. Clin. Med. 2021, 10, 2147. https://doi.org/10.3390/jcm10102147

AMA Style

Waligóra M, Gliniak M, Bylica J, Pasieka P, Łączak P, Podolec P, Kopeć G. Extended Precordial T Wave Inversions Are Associated with Right Ventricular Enlargement and Poor Prognosis in Pulmonary Hypertension. Journal of Clinical Medicine. 2021; 10(10):2147. https://doi.org/10.3390/jcm10102147

Chicago/Turabian Style

Waligóra, Marcin, Matylda Gliniak, Jan Bylica, Paweł Pasieka, Patrycja Łączak, Piotr Podolec, and Grzegorz Kopeć. 2021. "Extended Precordial T Wave Inversions Are Associated with Right Ventricular Enlargement and Poor Prognosis in Pulmonary Hypertension" Journal of Clinical Medicine 10, no. 10: 2147. https://doi.org/10.3390/jcm10102147

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