PAH, right ventricular hypertrophy prevalent in patients with ILD
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Key takeaways:
- Researchers utilized electrocardiography and echocardiography.
- In addition to PAH and right ventricular hypertrophy, some patients had diastolic dysfunction and left ventricular hypertrophy.
BOSTON — Among patients with interstitial lung disease, 30% had pulmonary arterial hypertension and 20% had right ventricular hypertrophy, according to data presented at the CHEST Annual Meeting.
“Clinicians should evaluate symptoms of ILD along with ECG and ECHO findings right at the time of first consultation — we would get indirect evidence of chronicity too,” Radha Munje, MBBS, DTCD, MD, FICS, professor and head of the department of respiratory medicine at Indira Gandhi Government Medical College and Hospital Nagpur, told Healio.
In this cross-sectional study utilizing electrocardiography (ECG) and 2D echocardiography, Munje and colleagues evaluated 150 patients with ILD to determine cardiac abnormality prevalence in this population.
During the assessment of ECG data, researchers reported that 60 patients (40%) had right axis deviation, and 30 patients (20%) had signs of right ventricular hypertrophy, totaling 90 patients with ECG abnormalities.
Switching to findings from echocardiography, the same number of patients with signs of right ventricular hypertrophy had this condition (n = 30), and nearly one-third of patients (n = 45; 30%) had pulmonary arterial hypertension (mean pulmonary artery pressure, 25 mmHg), according to the abstract.
Researchers reported smaller proportions of patients with diastolic dysfunction (n = 22; 14.67%) and left ventricular hypertrophy (n = 15; 10%) on echocardiography.
Lastly, the abstract indicated that two factors — longer ILD symptom duration and an idiopathic pulmonary fibrosis diagnosis — had correlation to greater PAH and right ventricular hypertrophy prevalence in this patient population.
“Now we need to see whether an equation can be developed, at what time duration there is cardiac involvement, plus is it multifactorial like exacerbations, etiology, duration of symptoms and treatment ongoing,” Munje told Healio.
For more information:
Radha Munje, MBBS, DTCD, MD, FICS, can be reached at radhamunje@yahoo.com.
Perspective
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This is an interesting study by Jhawar et al. Cardiac manifestations of ILD, namely pulmonary hypertension and right ventricular dysfunction, are serious clinical conditions that have significant impacts on shortness of breath, quality of life and mortality. It reflects the severity of their ILD. We know that echocardiogram is an effective screening tool for pulmonary hypertension in patients with ILD, but I was surprised at how many patients in the study had ECG changes reflective of right heart abnormalities, another marker of pulmonary hypertension.
We know that pulmonary hypertension is a common comorbidity of advanced ILD and can even become a bigger factor in patient symptoms of dyspnea, exercise limitation and oxygen requirement. I have found a similar proportion of patients with pulmonary hypertension among those with ILD and that echocardiogram can effectively identify those who may have pulmonary hypertension.
Finding easy and effective screening tools for pulmonary hypertension is essential in patients with ILD. Using ECG, a simple test available in most outpatient clinics, to identify potential right heart changes can potentially identify those with ILD and pulmonary hypertension sooner and allow for earlier intervention. Oftentimes, ECG can be more quickly obtained than an echocardiogram.
I would be very interested to see if the ECG findings of right axis deviation and/or right ventricular hypertrophy correlate with echocardiogram findings of pulmonary hypertension, as well as with pulmonary hypertension diagnosed via right heart catheterization. This could help validate these ECG findings as an early screening tool for pulmonary hypertension among patients with ILD.
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