Electrocardiographic right ventricular hypertrophy predicts the severity of pulmonary hypertension in patients with mitral stenosis

OBJECTIVES
Rheumatic heart disease is still common in developing countries. Mitral stenosis impedes left atrial emptying, increases left atrial and pulmonary venous pressure, and thus causes pulmonary hypertension. Pulmonary hypertension results in right ventricular hypertrophy (RVH), implying that the disease is long lasting and needs interventional treatment. The aim of our study was to predict the severity of pulmonary hypertension in patients with mitral stenosis by evaluating electrocardiographic RVH.

STUDY DESIGN
Patients admitted to our hospital with mitral stenosis were evaluated. Their clinical, electrocardiographic, and echocardiographic parameters were recorded. Electrocardiographic RVH was diagnosed when at least 2 of the following criteria were present at the same time: V1R+V5S or V6S >10.5 mm, V1R >6 mm, R >S in V1, V1 S <2 mm, V6 R/S <0.4, V5.6 R <3 mm, aVR R >4 mm, and right axis deviation.

RESULTS
Sixty-seven patients (13 males, 54 females; mean age: 44.9±14.5 years; range 18 to 80 years) were included in the study. One male patient and 14 female patients were diagnosed as having electrocardiographic RVH. Pulmonary arterial pressure, right atrial and ventricular dimensions, peak and mean transmitral gradients were higher, and mitral valve area was lower in patients with RVH. The presence of RVH predicted pulmonary arterial pressure as 60 mmHg or higher with the sensitivity of 93% and specificity of 92%.

CONCLUSION
Electrocardiographic RVH was found to be related to more severe mitral stenosis, higher pulmonary arterial pressure, and larger right heart chambers. RVH can be a simple and useful parameter to predict the severity of pulmonary hypertension.