Changes in surface electrocardiogram in patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy. Correlations with hemodynamic and echocardiographic improvements after surgery

• We studied 99 patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary endarterectomy.
• P wave amplitude in DII, R wave amplitude in V1 and the number of patients with negative T wave in V1–V3 decreased immediately after surgery, in parallel with the rapid improvement in right heart hemodynamics.
• S wave amplitude in V1, R:S wave ratio in lead V6 and prevalence of SIQIII pattern improved significantly at 1 year, in parallel with the reverse remodeling of the right ventricle at echocardiography.

BackgroundThe aim of the present study was to evaluate the changes of electrocardiographic (ECG) markers of right ventricular (RV) hypertrophy/overload in patients with chronic thromboembolic pulmonary hypertension (CTEPH) undergoing pulmonary endarterectomy (PEA).Methods and resultsWe evaluated 99 CTEPH patients who underwent PEA. P wave amplitude in DII, R wave amplitude in V1 and the number of patients with negative T wave in V1–V3 decreased significantly at 1 month after surgery with no further change at 1 year, in parallel with the rapid improvement in right heart hemodynamics. S wave amplitude in V1, R:S wave ratio in lead V6 and prevalence of SIQIII pattern improved significantly at 1 year, in parallel with the progressive reverse remodeling of the right ventricle at echocardiography.ConclusionsThe study shows that some of the ECG markers of RV hypertrophy/overload better reflect RV hemodynamic overload while others better reflect the pathologic remodeling of the right ventricle.