Background: The detection and treatment of pulmonary hypertension have become increasingly important for the clinician. While the electrocardiogram is often used as a screening tool in patients suspected of having pulmonary hypertension, the sensitivity for detecting right ventricular hypertrophy in the era of computerized electrocardiogram analysis is highly suspect. The aim of the study was to determine the importance of clinical information in providing an accurately edited electrocardiographic system.
Methods: The interpretation of the electrocardiograms of 64 consecutive symptomatic patients (12 males, 52 females, mean age 43 +/- 13 years) with isolated pulmonary hypertension provided by the computer program and the cardiologist following editing during routine daily reading sessions were reviewed. The reader (blinded cardiologist) was unaware of the clinical diagnosis. Subsequently, a cardiologist given clinical information regarding age and symptoms, edited the computer interpretation.
Results: The unblinded cardiologist diagnosed right axis deviation > 90 degrees, right ventricular hypertrophy, right ventricular strain, and right atrial enlargement in 76.6, 78.1, 71.9 and 20.3% of patients, respectively. In 6 (9.4%) patients, the electrocardiogram was normal. The blinded cardiologist and computer program diagnosed right ventricular hypertrophy in 43.8 and 39.1% respectively and most often characterized right ventricular strain as non-specific or inferior or as antero-lateral ischemia.
Conclusions: The electrocardiogram has a high degree of sensitivity for the detection of abnormalities in symptomatic patients with isolated pulmonary hypertension. Correlation with the clinical parameters is essential to optimize the usefulness of the electrocardiogram. Consideration should be given to tailoring computerized electrocardiogram interpretative software to clinical information.