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Pulmonary vascular disease
Original research article
Mechanisms of ECG signs in chronic obstructive pulmonary disease
  1. Marte Strømsnes Larssen1,2,
  2. Kjetil Steine1,3,
  3. Janne Mykland Hilde3,
  4. Ingunn Skjørten4,
  5. Christian Hodnesdal1,2,
  6. Knut Liestøl5 and
  7. Knut Gjesdal1,2⇑
  1. 1Faculty of Medicine, University of Oslo, Oslo, Norway
  2. 2Department of Cardiology Ullevål, Oslo University Hospital, Oslo, Norway
  3. 3Department of Cardiology, Akershus University Hospital, Oslo, Norway
  4. 4LHL-Clinics, Glittre, Hakadal, Norway
  5. 5Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
  1. Correspondence to Professor Knut Gjesdal; knut.gjesdal{at}medisin.uio.no

Abstract

Objective Patients with chronic obstructive pulmonary disease (COPD) often have abnormal ECGs. Our aim was to separate the effects on ECG by airway obstruction, emphysema and right ventricular (RV) afterload in patients with COPD.

Methods A cross-sectional study was performed on 101 patients with COPD without left heart disease and 32 healthy age-matched controls. Body mass index (BMI) was measured, and pulmonary function tests, ECG, echocardiography and right heart catheterisation (only patients) were performed. Variables were grouped into (1) airway obstruction by FEV% (percentage of forced expiratory volume)_predicted, (2) emphysema by residual volume/total lung capacity and residual volume (percent of predicted) and (3) RV afterload by mean pulmonary pressure, artery compliance, vascular resistance and RV wall thickness.

Results In multivariate regression analysis, emphysema correlated negatively to R+S amplitudes in horizontal and frontal leads, RV/left ventricle (LV) end-diastolic volume ratio to horizontal amplitudes and BMI negatively to frontal amplitudes. Increased airway obstruction, RV afterload and BMI correlated with horizontal QRS-axis clockwise rotation. Airway obstruction, RV afterload, RV/LV end-diastolic volume ratio and BMI correlated to the Sokolow-Lyon Index for RV, and RV afterload negatively to Sokolow-LyonIndex for LV. Several classical ECG changes could, however, not be ascribed to specific mechanisms.

Conclusions In COPD, the various pathophysiological mechanisms modify the ECG differently. Increased airway obstruction and RV afterload mainly increase the Sokolow-Lyon Index for RV mass and associate with clockwise rotation of the horizontal QRS-axis, whereas emphysema reduces the QRS amplitudes. BMI is an equally important determinant for the majority of the ECG changes.

  • electrocardiography
  • chronic lung disease
  • pulmonary vascular disease

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000552

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    Footnotes

    • Contributors MSL collected data, wrote the statistical analysis plan, analysed the data and drafted and revised the paper. KS collected data, drafted and revised the paper. JMH collected data, drafted and revised the paper. IS collected data, drafted and revised the paper. CH collected data, drafted and revised the paper. KL wrote the statistical analysis plan, analysed the data and revised the draft paper. KG wrote the statistical analysis plan, analysed the data and drafted and revised the paper.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Data sharing statement The authors accept data sharing on request.