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Title:: Association between pulmonary arterial pressure and electrocardiogram in cor pulmonale

作者:: 易仁亮¹; 邹霞英²; 辛达临³; 秦伟毅⁴; 江亚文¹; 广州军区广州总医院: 1.老年一科，2.呼吸内科，3.心内科，4.急诊危重病科，广东广州 510010

Author(s):: YI Renliang; ZOU Xiaying; XIN Dalin; QIN Weiyi; JIANG Yawen; 1. Department of Geriatrics， General Command of P.L.A., Guangzhou,Guangdong 510010, China

摘要:: 目的探讨肺心病患者心电图表现与肺动脉压力的关系。方法对肺心病103例，慢性阻塞性肺疾病(COPD)30例，进行心电图与血流动力学检查。按心电图表现分为4组，A组19例，B组28例，C组31例，D组25例，COPD为对照组30例。观察各组心电图改变与肺动脉压力的关系。并对各组患者随访5年，对所存活患者，重复首诊的各项检查。结果 ①各组患者肺动脉平均压(mPAP) ，A组22.1土1.6 mmHg，B组23.8土2.7 mmHg，C组31.4土9.1 mmHg，D组45.9土9.2 mmHg，对照组14.5土2.4 mmHg（1 mmHg=0.1333 kPa）。②103例肺心病5年死亡56例(54.4%)，其中D组5年死亡25例(100%)。5年存活47例，其中23例mPAP上升≥5 mmHg者，其心电图变化亦较前加重。③P波振幅与右心房平均压(mRAP) 、mPAP相关性差(r=0.13、r=0.15) 。结论 ①胸前导联呈QS波形、右侧胸前导联呈高大R波等，其mPAP多在30 mmHg以上，且预后差。②单独P波振幅≥0.22 mV特异性差。③心电图动态观察时，图形变坏常伴有肺动脉压力的升高。

Abstract:: AIM To explore the association between pulmonary arterial pressure and ECG in cor pulmonale. METHODS ECG and hemodynamics were observed simultaneously in 133 patients ( 103 with cor pulmonale, 30 with COPD ). According to the ECG，patients with cor pulmonale were divided into 4 groups: group A(n=19), group B (n=28), group C (n=31), group D (n=25). COPD patients were in the control (n=30) . A 5year follow-up was conducted in all patients. RESULT ①The mean mPAP was 22.1±1.6 mmHg in group A, 23.8±2.7 mmHg in group B, 31.4±9.1 mmHg in group C, 45.9±9.2 mmHg in group D and 14.5±2.4 mmHg in control group. ②Among the 103 patients with cor pulmonale 56 (54%) died within five years， 25(100%) from D group. In 47 survivors， mPAP elevated ≥5 mmHg in 20 patients with more severe ECG changes. ③ P wave amplitude was poorly correlated with either mean right artrium pressure (mRAP) (r=0.13) or mPAP(r=0.15). CONCLUSION ① QS and tall R wave amplitude in ECG, accompanied with mPAP ＞30 mmHg indicate a bad prognosis. ② Single P wave amplitude≥0.22 mV is not a reliable index. ③ In dynamic observation the worsening on ECG wave often an reflects increase of pulmonary artery pressure.