Electrocardiographic Characteristics And Their Relationship With Disease Severity In Chronic Pulmonary Artery Stenosis

Objective:To analyze the electrocardiographic characteristics of chronic pulmonary artery stenosis,and to explore the relationship between electrocardiogram and disease severity.Methods:A retrospective study was conducted to include patients diagnosed with chronic pulmonary stenosis in Gansu Provincial Hospital from January 2018 to July 2021.Electrocardiographic data such as heart rate,mean QRS axis,amplitude and duration of each lead were collected to analyze the electrocardiographic characteristics of patients with chronic pulmonary artery stenosis.Disease severity was reflected from the aspects of right heart function（right atrial area,right ventricular area,tricuspid annular plane systolic excursion,N-terminal pro-brain natriuretic peptide）,hemodynamics（right atrial pressure,mean pulmonary artery pressure,cardiac index,pulmonary vascular resistance,mixed venous oxygen saturation）and exercise ability（6-minute walking distance,World Health Organization functional class）,the relationship between electrocardiogram and right heart function,hemodynamics and exercise capacitywere explored by multiple regression analysis.Results:A total of 63 patients were included in this study,etiology including 38 patients with fibrosing mediastinitis,19 patients with chronic thromboembolic pulmonary hypertension,and 6 patients with takayasu’s arteritis-pulmonary artery involvement.The mean age of patients was 62.1±9.7 years,with 43 females 68.3%.The mean heart rate was80.4±13.4 bpm,and 30 patients（47.6%）had right axis deviation.2 patients（3.2%）had QRS duration≥120 ms.In the electrocardiographic criteria of right ventricular hypertrophy,the most prevalent electrocardiographic criterion was（R_Ⅰ+S_Ⅲ）-（S_Ⅰ+R_Ⅲ）<1.5 Mv（98.4%）,and the least prevalent criteria were V₅lead R:S ratio<V₁lead R:S ratio<0.04（0）and V₆lead R:S ratio<0.4（0）.There were 10 patients（15.9%）with flat or inverted T waves in all precordial leads（V₁-V₆）.There were 18 patients（28.6%）with flat or inverted T waves in inferior leads（Ⅱ,Ⅲ,a VF）.There were 4 patients（6.3%）with flat or inverted T waves in high lateral leads（I,a VL）.After multiple regression analysis,some electrocardiographic characteristics had different degrees of linear correlation with the parameters reflecting right heart function and hemodynamics,and there was no significant correlation with the parameters reflecting exercise ability.Conclusion:There were different proportions of electrocardiographic characteristics in chronic pulmonary artery stenosis,but some electrocardiographic characteristics can reflect the disease severity of patients.In clinical work,selected appropriate electrocardiographic characteristics can evaluate condition of patients with chronic pulmonary artery stenosis and help to improve the prognosis of patients.