Clinical implication of electrocardiogram change in patients experiencing lung transplantation with end stage lung disease

Ah Young Leem; Hee Tae Yu; MinDong Sung; Kyung Soo Chung; Yeonkyeong Kim; Ala Woo; Song Yee Kim; Moo Suk Park; Young Sam Kim; Young Ho Yang; Ha Eun Kim; Jin Gu Lee; Kyuseok Kim; Kyu Bom Kim; Boyoung Joung; Junbeom Park; Su Hwan Lee

doi:10.3389/fphys.2024.1440307

Clinical implication of electrocardiogram change in patients experiencing lung transplantation with end stage lung disease

Front Physiol. 2024 Oct 29:15:1440307. doi: 10.3389/fphys.2024.1440307. eCollection 2024.

Authors

Ah Young Leem^#¹, Hee Tae Yu^#², MinDong Sung¹, Kyung Soo Chung¹, Yeonkyeong Kim¹, Ala Woo¹, Song Yee Kim¹, Moo Suk Park¹, Young Sam Kim¹, Young Ho Yang³, Ha Eun Kim³, Jin Gu Lee³, Kyuseok Kim⁴, Kyu Bom Kim⁵, Boyoung Joung², Junbeom Park^#^{6

7}, Su Hwan Lee^#¹

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
² Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
³ Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
⁴ Department of Biomedical Engineering, Eulji University, Seoul, Republic of Korea.
⁵ Department of Radiation Convergence Engineering, College of Health Science, Yonsei University, Wonju, Gangwon, Republic of Korea.
⁶ Division of Cardiology, Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
⁷ Department of Biomedical Engineering, Emory University School of Medicine, Atlanta, GA, United States.

^# Contributed equally.

Abstract

Introduction: End-stage lung disease causes cardiac remodeling and induces electrocardiogram (ECG) changes. On the other way, whether lung transplantation (LTx) in end-stage lung disease patients are associated with ECG change is unknown. The object of this study was to investigate ECG changes before and after LTx in end-stage lung disease patients and whether these changes had clinical significance.

Method: This was a single-center retrospective cohort study of 280 end-stage lung disease patients who consecutively underwent LTx at a tertiary referral hospital. ECG findings before LTx and within 1 week and 1, 3, and 6 months after LTx were obtained and analyzed. To find clinical meaning, the ECG at 1 month after LTx was analyzed according to 1-year survival (survivor vs non-survivor groups). Survival data were estimated using the Kaplan-Meier method.

Results: Significant differences were observed in the PR interval, QRS duration, QT interval, QTc interval, and heart rate before LTx and 1 month after LTx; the PR interval, QRS duration, QTc interval, and heart rate were decreased. Particularly, the QTc interval was significantly decreased 1 month after LTx, whereas there was no significant change in the QTc interval from 1 to 6 months thereafter. The PR interval, QT interval, QTc interval, and heart rate were significantly different between the survivor and non-survivor groups. The serial changes in QTc interval before LTx and 1 and 3 months after LTx were also significantly different between the survivor and non-survivor groups (p = 0.040 after adjusting for age and body mass index). Upon dividing the patients based on the range of QTc interval change ≤ -8 ms, >-8-10 ms, >10-35 ms, >35 ms), the survival rate was significantly lower in the group whose QTc interval at 1 month after LTx decreased by > 35 m (p = 0.019).

Conclusion: LTx in patients with end-stage lung disease may induce ECG changes. Patients whose QTc interval at 1 month after LTx decreased by > 35 ms have a significantly higher 1-year mortality rate. Hence, these ECG changes may have clinical and prognostic significance.

Keywords: electrocardiogram; end-stage lung disease; lung transplantation; prognosis; risk factor.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Korea Medical Device Development Fund awarded by the Korean government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health and Welfare, the Ministry of Food and Drug Safety) (Project Number: RS-2020-KD000032), the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (RS-2023-00252863), the Ministry of Science, ICT and Future Planning (NRF-2022R1A2C1093352) and Institute of Information and communications Technology Planning and Evaluation (IITP) grant funded by the Korea government (MSIT) (No. RS-2022-00155966, Artificial Intelligence Convergence Innovation Human Resources Development (Ewha Womans University).