Clinical Utility of the Electrocardiographic P-Wave Axis in Patients with Chronic Obstructive Pulmonary Disease

Shiro Otake, Shotaro Chubachi, Shingo Nakayama, Kaori Sakurai, Hidehiro Irie, Mizuha Hashiguchi, Yuji Itabashi, Yoshitake Yamada, Masahiro Jinzaki, Mitsuru Murata, Hidetoshi Nakamura, Koichiro Asano, Koichi Fukunaga

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)345-352
Number of pages8
JournalRespiration
Volume101
Issue number4
DOIs
Publication statusPublished - 2022 Apr 1

Keywords

  • Chronic obstructive pulmonary disease
  • Electrocardiography
  • Emphysema
  • P-wave axis
  • QRS-wave axis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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