Clinical Utility of the Electrocardiographic P-Wave Axis in Patients with Chronic Obstructive Pulmonary Disease
Background: The vertical P-wave axis on electrocardiography (ECG) is a useful criterion for screening patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the clinical characteristics of patients with COPD with a vertical P-wave axis as they have not yet been e...
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| Veröffentlicht in: | Respiration 2022-04, Vol.101 (4), p.345-352 |
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| creator | Otake, Shiro Chubachi, Shotaro Nakayama, Shingo Sakurai, Kaori Irie, Hidehiro Hashiguchi, Mizuha Itabashi, Yuji Yamada, Yoshitake Jinzaki, Masahiro Murata, Mitsuru Nakamura, Hidetoshi Asano, Koichiro Fukunaga, Koichi |
| description | Background: The vertical P-wave axis on electrocardiography (ECG) is a useful criterion for screening patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the clinical characteristics of patients with COPD with a vertical P-wave axis as they have not yet been elucidated. Methods: Keio University and its affiliated hospitals conducted an observational COPD cohort study over 3 years. We analyzed 201 patients using ECG and chest computed tomography. Results: The severity of airflow limitation was higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. Patients with a P-wave axis >75° exhibited significantly higher total COPD assessment test scores and increased St. George’s Respiratory Questionnaire total, activity, and impact scores than those with a P-wave axis ≤75°. The incidence of exacerbations over 1 and 3 years was significantly higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. The optimal cutoff for the P-wave axis for a percentage of the predicted forced expiratory volume in 1 s 75° than in those with a P-wave axis ≤75°. However, the ratio of the airway wall area did not differ between the 2 groups. Conclusions: Patients with COPD with a vertical P-wave axis exhibited severe airflow limitation and emphysema, a worse health status, and more frequent exacerbation than patients without a vertical P-wave. Detection of the vertical P-wave axis by ECG is beneficial for the management of patients with COPD. |
| doi_str_mv | 10.1159/000519668 |
| format | Article |
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This study aimed to investigate the clinical characteristics of patients with COPD with a vertical P-wave axis as they have not yet been elucidated. Methods: Keio University and its affiliated hospitals conducted an observational COPD cohort study over 3 years. We analyzed 201 patients using ECG and chest computed tomography. Results: The severity of airflow limitation was higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. Patients with a P-wave axis >75° exhibited significantly higher total COPD assessment test scores and increased St. George’s Respiratory Questionnaire total, activity, and impact scores than those with a P-wave axis ≤75°. The incidence of exacerbations over 1 and 3 years was significantly higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. The optimal cutoff for the P-wave axis for a percentage of the predicted forced expiratory volume in 1 s <50% and future exacerbations over 3 years was 70° (the areas under the curve [AUC]: 0.788; sensitivity: 65.3%; specificity: 78.3%) and 79° (AUC: 0.642; sensitivity: 36.7%; specificity: 92.6%). The ratio of the low attenuation area was also significantly higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. However, the ratio of the airway wall area did not differ between the 2 groups. Conclusions: Patients with COPD with a vertical P-wave axis exhibited severe airflow limitation and emphysema, a worse health status, and more frequent exacerbation than patients without a vertical P-wave. Detection of the vertical P-wave axis by ECG is beneficial for the management of patients with COPD.</description><identifier>ISSN: 0025-7931</identifier><identifier>EISSN: 1423-0356</identifier><identifier>DOI: 10.1159/000519668</identifier><identifier>PMID: 34784604</identifier><language>eng</language><publisher>Basel, Switzerland: S. Karger AG</publisher><subject>Clinical Investigations ; Cohort Studies ; Diagnosis ; Electrocardiogram ; Electrocardiography ; Forced Expiratory Volume ; Humans ; Lung diseases, Obstructive ; Methods ; Patient outcomes ; Physiological aspects ; Pulmonary Disease, Chronic Obstructive ; Pulmonary Emphysema - diagnosis</subject><ispartof>Respiration, 2022-04, Vol.101 (4), p.345-352</ispartof><rights>2021 The Author(s). Published by S. Karger AG, Basel</rights><rights>2021 The Author(s). Published by S. Karger AG, Basel.</rights><rights>COPYRIGHT 2022 S. Karger AG</rights><rights>Copyright © 2021 by S. Karger AG, Basel 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c522t-7e8121dfafb7ba86910066b6760bae593bfa856336179a7203132900a2d5c4983</citedby><cites>FETCH-LOGICAL-c522t-7e8121dfafb7ba86910066b6760bae593bfa856336179a7203132900a2d5c4983</cites><orcidid>0000-0002-9044-3061 ; 0000-0002-5842-5349</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,781,785,886,2430,27926,27927</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34784604$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Otake, Shiro</creatorcontrib><creatorcontrib>Chubachi, Shotaro</creatorcontrib><creatorcontrib>Nakayama, Shingo</creatorcontrib><creatorcontrib>Sakurai, Kaori</creatorcontrib><creatorcontrib>Irie, Hidehiro</creatorcontrib><creatorcontrib>Hashiguchi, Mizuha</creatorcontrib><creatorcontrib>Itabashi, Yuji</creatorcontrib><creatorcontrib>Yamada, Yoshitake</creatorcontrib><creatorcontrib>Jinzaki, Masahiro</creatorcontrib><creatorcontrib>Murata, Mitsuru</creatorcontrib><creatorcontrib>Nakamura, Hidetoshi</creatorcontrib><creatorcontrib>Asano, Koichiro</creatorcontrib><creatorcontrib>Fukunaga, Koichi</creatorcontrib><title>Clinical Utility of the Electrocardiographic P-Wave Axis in Patients with Chronic Obstructive Pulmonary Disease</title><title>Respiration</title><addtitle>Respiration</addtitle><description>Background: The vertical P-wave axis on electrocardiography (ECG) is a useful criterion for screening patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the clinical characteristics of patients with COPD with a vertical P-wave axis as they have not yet been elucidated. Methods: Keio University and its affiliated hospitals conducted an observational COPD cohort study over 3 years. We analyzed 201 patients using ECG and chest computed tomography. Results: The severity of airflow limitation was higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. Patients with a P-wave axis >75° exhibited significantly higher total COPD assessment test scores and increased St. George’s Respiratory Questionnaire total, activity, and impact scores than those with a P-wave axis ≤75°. The incidence of exacerbations over 1 and 3 years was significantly higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. The optimal cutoff for the P-wave axis for a percentage of the predicted forced expiratory volume in 1 s <50% and future exacerbations over 3 years was 70° (the areas under the curve [AUC]: 0.788; sensitivity: 65.3%; specificity: 78.3%) and 79° (AUC: 0.642; sensitivity: 36.7%; specificity: 92.6%). The ratio of the low attenuation area was also significantly higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. However, the ratio of the airway wall area did not differ between the 2 groups. Conclusions: Patients with COPD with a vertical P-wave axis exhibited severe airflow limitation and emphysema, a worse health status, and more frequent exacerbation than patients without a vertical P-wave. Detection of the vertical P-wave axis by ECG is beneficial for the management of patients with COPD.</description><subject>Clinical Investigations</subject><subject>Cohort Studies</subject><subject>Diagnosis</subject><subject>Electrocardiogram</subject><subject>Electrocardiography</subject><subject>Forced Expiratory Volume</subject><subject>Humans</subject><subject>Lung diseases, Obstructive</subject><subject>Methods</subject><subject>Patient outcomes</subject><subject>Physiological aspects</subject><subject>Pulmonary Disease, Chronic Obstructive</subject><subject>Pulmonary Emphysema - diagnosis</subject><issn>0025-7931</issn><issn>1423-0356</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>M--</sourceid><sourceid>EIF</sourceid><recordid>eNpt0s2L1DAUAPAgijuOHryLBBZED13z0aTNRRjG2VVY2EFdPIY0TafRtJlN0tX97-3QtezAJodA3u89XsID4DVGZxgz8REhxLDgvHwCFjgnNEOU8adggRBhWSEoPgEvYvyFEGZlSZ6DE5oXZc5RvgB-7WxvtXLwOlln0x30DUytgRtndApeq1Bbvwtq31oNt9lPdWvg6q-N0PZwq5I1fYrwj00tXLfBj6XgVRVTGHSyo9wOrvO9Cnfws41GRfMSPGuUi-bV_bkE1-ebH-sv2eXVxdf16jLTjJCUFabEBNeNaqqiUiUXGCHOK15wVCnDBK0aVTJOKceFUAVBFFMiEFKkZjoXJV2CT1Pd_VB1ptZjm0E5uQ-2G7uRXll5HOltK3f-VgrM6GEtwfv7AsHfDCYm2dmojXOqN36IkjBRshwzTkZ6OtGdckbavvFjRX3gclUgIRAR5UGdPaLGXZvOat-bxo73RwnvHiS0RrnURu-GZH0fj-GHCergYwymmZ-JkTwMiJwHZLRvH_7LLP9PxAjeTOC3CjsTZjDnnz4a_rb5Pgm5rxv6D63vyWo</recordid><startdate>20220401</startdate><enddate>20220401</enddate><creator>Otake, Shiro</creator><creator>Chubachi, Shotaro</creator><creator>Nakayama, Shingo</creator><creator>Sakurai, Kaori</creator><creator>Irie, Hidehiro</creator><creator>Hashiguchi, Mizuha</creator><creator>Itabashi, Yuji</creator><creator>Yamada, Yoshitake</creator><creator>Jinzaki, Masahiro</creator><creator>Murata, Mitsuru</creator><creator>Nakamura, Hidetoshi</creator><creator>Asano, Koichiro</creator><creator>Fukunaga, Koichi</creator><general>S. Karger AG</general><scope>M--</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-9044-3061</orcidid><orcidid>https://orcid.org/0000-0002-5842-5349</orcidid></search><sort><creationdate>20220401</creationdate><title>Clinical Utility of the Electrocardiographic P-Wave Axis in Patients with Chronic Obstructive Pulmonary Disease</title><author>Otake, Shiro ; Chubachi, Shotaro ; Nakayama, Shingo ; Sakurai, Kaori ; Irie, Hidehiro ; Hashiguchi, Mizuha ; Itabashi, Yuji ; Yamada, Yoshitake ; Jinzaki, Masahiro ; Murata, Mitsuru ; Nakamura, Hidetoshi ; Asano, Koichiro ; Fukunaga, Koichi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c522t-7e8121dfafb7ba86910066b6760bae593bfa856336179a7203132900a2d5c4983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Clinical Investigations</topic><topic>Cohort Studies</topic><topic>Diagnosis</topic><topic>Electrocardiogram</topic><topic>Electrocardiography</topic><topic>Forced Expiratory Volume</topic><topic>Humans</topic><topic>Lung diseases, Obstructive</topic><topic>Methods</topic><topic>Patient outcomes</topic><topic>Physiological aspects</topic><topic>Pulmonary Disease, Chronic Obstructive</topic><topic>Pulmonary Emphysema - diagnosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Otake, Shiro</creatorcontrib><creatorcontrib>Chubachi, Shotaro</creatorcontrib><creatorcontrib>Nakayama, Shingo</creatorcontrib><creatorcontrib>Sakurai, Kaori</creatorcontrib><creatorcontrib>Irie, Hidehiro</creatorcontrib><creatorcontrib>Hashiguchi, Mizuha</creatorcontrib><creatorcontrib>Itabashi, Yuji</creatorcontrib><creatorcontrib>Yamada, Yoshitake</creatorcontrib><creatorcontrib>Jinzaki, Masahiro</creatorcontrib><creatorcontrib>Murata, Mitsuru</creatorcontrib><creatorcontrib>Nakamura, Hidetoshi</creatorcontrib><creatorcontrib>Asano, Koichiro</creatorcontrib><creatorcontrib>Fukunaga, Koichi</creatorcontrib><collection>Karger Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Respiration</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Otake, Shiro</au><au>Chubachi, Shotaro</au><au>Nakayama, Shingo</au><au>Sakurai, Kaori</au><au>Irie, Hidehiro</au><au>Hashiguchi, Mizuha</au><au>Itabashi, Yuji</au><au>Yamada, Yoshitake</au><au>Jinzaki, Masahiro</au><au>Murata, Mitsuru</au><au>Nakamura, Hidetoshi</au><au>Asano, Koichiro</au><au>Fukunaga, Koichi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical Utility of the Electrocardiographic P-Wave Axis in Patients with Chronic Obstructive Pulmonary Disease</atitle><jtitle>Respiration</jtitle><addtitle>Respiration</addtitle><date>2022-04-01</date><risdate>2022</risdate><volume>101</volume><issue>4</issue><spage>345</spage><epage>352</epage><pages>345-352</pages><issn>0025-7931</issn><eissn>1423-0356</eissn><abstract>Background: The vertical P-wave axis on electrocardiography (ECG) is a useful criterion for screening patients with chronic obstructive pulmonary disease (COPD). This study aimed to investigate the clinical characteristics of patients with COPD with a vertical P-wave axis as they have not yet been elucidated. Methods: Keio University and its affiliated hospitals conducted an observational COPD cohort study over 3 years. We analyzed 201 patients using ECG and chest computed tomography. Results: The severity of airflow limitation was higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. Patients with a P-wave axis >75° exhibited significantly higher total COPD assessment test scores and increased St. George’s Respiratory Questionnaire total, activity, and impact scores than those with a P-wave axis ≤75°. The incidence of exacerbations over 1 and 3 years was significantly higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. The optimal cutoff for the P-wave axis for a percentage of the predicted forced expiratory volume in 1 s <50% and future exacerbations over 3 years was 70° (the areas under the curve [AUC]: 0.788; sensitivity: 65.3%; specificity: 78.3%) and 79° (AUC: 0.642; sensitivity: 36.7%; specificity: 92.6%). The ratio of the low attenuation area was also significantly higher in patients with a P-wave axis >75° than in those with a P-wave axis ≤75°. However, the ratio of the airway wall area did not differ between the 2 groups. Conclusions: Patients with COPD with a vertical P-wave axis exhibited severe airflow limitation and emphysema, a worse health status, and more frequent exacerbation than patients without a vertical P-wave. Detection of the vertical P-wave axis by ECG is beneficial for the management of patients with COPD.</abstract><cop>Basel, Switzerland</cop><pub>S. Karger AG</pub><pmid>34784604</pmid><doi>10.1159/000519668</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-9044-3061</orcidid><orcidid>https://orcid.org/0000-0002-5842-5349</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Clinical Investigations Cohort Studies Diagnosis Electrocardiogram Electrocardiography Forced Expiratory Volume Humans Lung diseases, Obstructive Methods Patient outcomes Physiological aspects Pulmonary Disease, Chronic Obstructive Pulmonary Emphysema - diagnosis |
| title | Clinical Utility of the Electrocardiographic P-Wave Axis in Patients with Chronic Obstructive Pulmonary Disease |
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