Efficacy of Electrocardiographic Findings for Prediction of Moderate to Severe Pulmonary Hypertension in Patients with Mitral Stenosis

Background: Mitral stenosis (MS) is the most common valvular heart disease throughout the world. Pulmonary hypertension is an important and grave hemodynamic consequence of mitral stenosis. Persistent pulmonary hypertension leads to increase right heart pressure, Right Ventricular Hypertrophy (RVH) and subsequently right heart failure. There are various electrocardiographic parameters and criteria of Right Ventricular Hypertrophy (RVH) for diagnosis of pulmonary hypertension in various disease. Different ECG parameters and criteria of Right Ventricular Hypertrophy (RVH) have different predictive value for diagnosis of pulmonary hypertension in MS patient. Echocardiography is an important non-invasive investigation for diagnosis, monitoring and selection of treatment and for prediction of mortality in MS patient. Obtaining good quality of 2D echocardiography is problematic in remote areas and they are not feasible for wide spread use due to cost and availability. So, ECG may be a guide for selecting appropriate patient for further testing. Objectives: This study was planned to identify more accurate parameters of ECG for prediction of pulmonary hypertension and Right Ventricular Hypertrophy (RVH) in patients with mitral stenosis. Methodology: This cross-sectional observational study was conducted in the Department of Cardiology, DMCH, from March 2018 to February 2019. A total of 100 patients with mitral stenosis (MS) who met the inclusion and exclusion criteria were enrolled. Detailed clinical history, physical examination, and baseline investigations were recorded for all participants. The study population was divided into two groups: Group I:MS patients without pulmonary hypertension (PASP 1 andR in V1+S in V5 ≥ 10 mm had good sensitivity (60.5% and 63.2%; 65.1% and 68.4%; 53.5% and 63.2% respectively), good specificity (100% and 100%; 100% and 100%; 100% and 100% respectively), good PPV (100% and 100%; 100% and 100%; 100% and 100% respectively) and NPV (19% and 22.2%; 21.1% and 25%; 16.7% and 22.2% respectively). Conclusion: The sensitivity of the ECG parameters was as a whole low to moderate in detection of pulmonary hypertension by assessing presence of RVH. However, certain ECG criteria for RVH detection in mitral stenosis patients have acceptable predictive value only in moderate to severe pulmonary hypertension.