Spatial QRS-T angle and electrocardiographic ventricular gradient in different forms of pre-capillary pulmonary hypertension

Sakhnova T.A.; Blinova E.V.; Arkhipova O.A.; Yurasova E.S.; Saidova M.A.; Martynyuk T.V.

doi:https://doi.org/10.17116/Cardiobulletin20191401140

Sakhnova T.A.

Federal State Budget Organization National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, 3 ,Cherepkovskaya Str. 15a, 121552, Moscow, Russian Federation

Blinova E.V.

Federal State Budget Organization National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, 3 ,Cherepkovskaya Str. 15a, 121552, Moscow, Russian Federation

Arkhipova O.A.

Institute of the Clinical Cardiology named after A.L. Myasnikov of National Medical Research Center for Cardiology, Moscow, Russia

Yurasova E.S.

Federal State Budget Organization National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, 3 ,Cherepkovskaya Str. 15a, 121552, Moscow, Russian Federation

Saidova M.A.

National medical research center of cardiology MH RF

Martynyuk T.V.

The Institute of Clinical Cardiology named after A.L. Myasnikov, Federal State Institution «National Medical Research Center of Сardiology», Moscow, Russia

Scopus AuthorID: 6602715051
ORCID: 0000-0002-9022-8097

Spatial QRS-T angle and electrocardiographic ventricular gradient in different forms of pre-capillary pulmonary hypertension

Authors:

Sakhnova T.A., Blinova E.V., Arkhipova O.A., Yurasova E.S., Saidova M.A., Martynyuk T.V.

More about the authors

Journal: Russian Cardiology Bulletin. 2019;14(1): 40‑45

DOI: 10.17116/Cardiobulletin20191401140

Read: 3089 times

Download PDF (RU)

Contact the author

Table of contents

To cite this article:

Sakhnova TA, Blinova EV, Arkhipova OA, Yurasova ES, Saidova MA, Martynyuk TV. Spatial QRS-T angle and electrocardiographic ventricular gradient in different forms of pre-capillary pulmonary hypertension. Russian Cardiology Bulletin. 2019;14(1):40‑45. (In Russ.)
https://doi.org/10.17116/Cardiobulletin20191401140

Подписка 2026 Кардиологический вестник (Russian Cardiology Bulletin)

Использование инфографики авторами научных работ

Close metadata

Recommended articles:

Dynamics of vector electrocardiography parameters in patients with chronic heart failure under optimal drug therapy. Russian Cardiology Bulletin. 2025;(1):57-63

Abstract:

Introduction. Pre-capillary pulmonary hypertension (PH), including pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), is a severe condition leading to right heart failure and death. In these patients timely diagnosis, risk stratification and treatment are of extreme importance. The aim of the study was to investigate the changes of the electrocardiogram-derived ventricular gradient (VG) and spatial QRS-T angle in different forms of pre-capillary PH. Methods. We examined 3 groups of female PH patients: 21 with idiopathic PAH (IPH, mean age 50±6 years); 18 with PAH associated with systemic sclerosis (SS, 58±10 years); 21 with CTEPH (54±8 years). 30 healthy females (55±9 years) comprised the control group. Spatial QRS-T angle and VG were calculated using digital derived vectorcardiogram. Systolic pulmonary artery pressure (SPAP), right ventricular anterior-posterior dimension (RV APD) and right atrial area (RAA) were estimated using transthoracic echocardiography. Results. As compared with normal group in PH patients QRS-T angle was significantly increased, VG significantly decreased. These changes were the most pronounced in patients with SS: QRS-T angle, degrees: 49±20 in normal group; 90±41 in IPH; 89±40 in CTEPH; 122±31 in SS; VG, mV*ms: 77±13 in normal group; 48±26 in CTEPH; 34±14 in IPH; 30±17 in SS. Groups of PH patients had no statistically significant differences in SPAP and RV APD. RAA was greater in SS (27±7 cm2) as compared with IPH (23±6 cm2) and CTEPH (22±7 cm2). QRS-T angle correlated with RAA (r=0.4, p<0.01). VG correlated with RAA (r= –0.4, p<0.01), SPAP (r= –0.3, p<0.05), RV APD (r= –0.3, p<0.05) and heart rate (r= –0.4, p<0.01). Conclusions. Patients with PAH associated with SS were characterized with the most pronounced changes in spatial QRS-T angle and VG as compared with IPH and CTEPH. In patients with pre-capillary PH spatial QRS-T angle and VG had statistically significant correlations with RAA — important echocardiographic predictor of poor prognosis.

Keywords:

derived vectorcardiogram

precapillary pulmonary hypertension

systemic sclerosis

spatial QRS-T angle

ventricular gradient

Authors:

Sakhnova T.A.

Federal State Budget Organization National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, 3 ,Cherepkovskaya Str. 15a, 121552, Moscow, Russian Federation

Blinova E.V.

Federal State Budget Organization National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, 3 ,Cherepkovskaya Str. 15a, 121552, Moscow, Russian Federation

Arkhipova O.A.

Institute of the Clinical Cardiology named after A.L. Myasnikov of National Medical Research Center for Cardiology, Moscow, Russia

Yurasova E.S.

Federal State Budget Organization National Medical Research Center of Cardiology, Ministry of Healthcare Russian Federation, 3 ,Cherepkovskaya Str. 15a, 121552, Moscow, Russian Federation

Saidova M.A.

National medical research center of cardiology MH RF

Martynyuk T.V.

The Institute of Clinical Cardiology named after A.L. Myasnikov, Federal State Institution «National Medical Research Center of Сardiology», Moscow, Russia

Scopus AuthorID: 6602715051
ORCID: 0000-0002-9022-8097

Close metadata

References:

Chazova IE, Avdeev SN, Tsareva NA, Volkov AV, Martynyuk TV, Nakonechnikov SN. Clinical guidelines for the diagnosis and treatment of pulmonary hypertension. Terapevticheskiy arkhiv (Therapeutic archive). 2014;9:4-23. (In Russ.)
Kamphuis VP, Haeck ML, Wagner GS, Maan AC, Maynard C, Delgado V, Vliegen HW, Swenne CA. Electrocardiographic detection of right ventricular pressure overload in patients with suspected pulmonary hypertension. J Electrocardiol. 2014;47(2):175-182. https://doi.org/10.1016/j.jelectrocard.2013.10.010
Blinova EV, Sakhnova TA, Saidova MA, Loskutova AS, Ryabykina GV, Arkhipova OA, Martynyuk TV, Trunov VG, Aidu EA, Chazova IE. Comparison of vectorcardiographic parameters with structural-functional state of the right ventricle in patients with pulmonary hypertension. Systemic Hypertension. 2015;12(4):57-60. (In Russ.)
Scherptong RW, Henkens IR, Kapel GF, Swenne CA, van Kralingen KW, Huisman MV, Schuerwegh AJ, Bax JJ, van der Wall EE, Schalij MJ, Vliegen HW. Diagnosis and mortality prediction in pulmonary hypertension: the value of the electrocardiogram-derived ventricular gradient. J Electrocardiol. 2012;45(3):312-318. https://doi.org/10.1016/j.jelectrocard.2011.12.001
Couperus LE, Vliegen HW, Henkens IR, Maan AC, Treskes RW, de Vries JK, Schouffoer AA, Swenne CA, Schalij MJ, Scherptong RW. Electrocardiographic detection of pulmonary hypertension in patients with systemic sclerosis using the ventricular gradient. J Electrocardiol. 2016;49(1):60-68. https://doi.org/10.1016/j.jelectrocard.2015.09.003
Trunov VG, Aidu EA, Blinova EV, Sakhnova TA. Synthesis of McFee-Parungao corrected orthogonal lead system signals from 12 lead electrocardiogram. Meditsinskiy alfavit. Sovremennaya funktsional’naya diagnostika (Medical alphabet. Modern functional diagnostics). 2017;14(311):16-20. (In Russ.)
Blinova EV, Sakhnova TA. Vectorcardiography. In: Rukovodstvo po kardiologii. Ed. Chazov Ye.I. V. 2. M.: Praktika; 2014. (In Russ.)
Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, Solomon SD, Louie EK, Schiller NB. Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr. 2010;23(7):685-713; 786-788. https://doi.org/10.1016/j.echo.2010.05.010
Yudkina NN, Volkov AV. Pulmonary arterial hypertension associated with a systemic sclerosis: review of literature. Eurasian heart journal. 2015;4:32-39. (In Russ.)
Chazova IE, Martynyuk TV. Focus on pulmonary arterial hypertension. Meditsinskiy alfavit. Arterial’naya gipertenziya (Medical alphabet. Arterial hypertension). 2016;31(294):28-33. (In Russ.)
Henkens IR, Mouchaers KT, Vliegen HW, van der Laarse WJ, Swenne CA, Maan AC, Draisma HH, Schalij I, van der Wall EE, Schalij MJ, Vonk-Noordegraaf A. Early changes in rat hearts with developing pulmonary arterial hypertension can be detected with three-dimensional electrocardiography. Am J Physiol Heart Circ Physiol. 2007;293(2):1300-1307. https://doi.org/10.1152/ajpheart.01359.2006
Piao L, Fang YH, Cadete VJ, Wietholt C, Urboniene D, Toth PT, Marsboom G, Zhang HJ, Haber I, Rehman J, Lopaschuk GD, Archer SL. The inhibition of pyruvate dehydrogenase kinase improves impaired cardiac function and electrical remodeling in two models of right ventricular hypertrophy: resuscitating the hibernating right ventricle. J Mol Med (Berl). 2010;88(1):47-60. https://doi.org/10.1007/s00109-009-0524-6
Jeyaraj D, Wilson LD, Zhong J, Flask C, Saffitz JE, Deschênes I, Yu X, Rosenbaum DS. Mechanoelectrical feedback as novel mechanism of cardiac electrical remodeling. Circulation. 2007;115(25):3145-3155. https://doi.org/10.1161/CIRCULATIONAHA.107.688317
Overbeek MJ, Lankhaar JW, Westerhof N, Voskuyl AE, Boonstra A, Bronzwaer JG, Marques KM, Smit EF, Dijkmans BA, Vonk-Noordegraaf A. Right ventricular contractility in systemic sclerosis-associated and idiopathic pulmonary arterial hypertension. Eur Respir J. 2008;31(6):1160-1166. https://doi.org/10.1183/09031936.00135407
Arkhipova OA, Valieva ZS, Martynyuk TV, Nakonechnikov SN, Chazova IYe. Features of pulmonary arterial hypertension in the Russian register. Eurasian heart journal. 2014;4:44-53. (In Russ.)