Surface electrocardiogram detects signs of right ventricular pressure overload among acute-decompensated heart failure with preserved ejection fraction patients

Abstract

Background: Pulmonary hypertension (PH) is a common finding among patients with heart failure and preserved ejection fraction (HFpEF) and contributes to develop right ventricular systolic dysfunction (RVSD).

Aims: We evaluated the diagnostic accuracy of Flowers and Horan electrocardiographic criteria to detect significant right ventricular pressure overload.

Methods: 123 patients were prospectively included. We used the Flowers and Horan (FH) ECG criteria to define RV enlargement (score >10). Echocardiographic measurements were performed blinded to the electrocardiographic results.

Results: Severe PH was found in 51.5%. Seventeen patients (16.5%) had a FH score >10 points. This was associated to RVSD (RR 2.66; 1.51-4.67 CI 95%, p=0.002), with 90.5% specificity and 34.4% sensitivity and to severe PH (RR 1.70; 1.16-2.50 CI 95%, p=0.028) with 91.9% specificity and 27.5% sensitivity.

Conclusions: The ECG is a useful tool to classify HFpEF patients with echocardiographic signs of right ventricular pressure overload, in the absence of RBBB.

Keywords: Flowers and Horan ECG criteria; Heart failure with preserved ejection fraction; pulmonary hypertension.