Electrocardiogram signs of right ventricular hypertrophy may help identify pulmonary hypertension in patients with dilated cardiomyopathy.

Objective: To the authors' knowledge, limited data are available regarding the association between Electrocardiogram (ECG) signs of right ventricular hypertrophy (RVH) and pulmonary hypertension (PH) in patients with dilated cardiomyopathy (DCM). We aimed to assess the accuracy of the recommended ECG criteria of RVH for predicting PH in patients with DCM.

Methods: According to the definition of PH (mPAP ≥ 25 mm Hg), 35 patients with DCM were divided into 2 groups: DCM with PH (n = 22) and DCM without PH (n = 13). Right heart catheterization was performed in all patients. Seventeen parameters of RVH recommended by the AHA/ACCF/HRS for diagnosis of RVH on ECG were determinded.

Results: The following parameters were correlated with mPAP: RV1  > 6 mm, SV5  > 10 mm, R:SV6  < 0.4, RV1  + SV5 or V6  > 10.5 mm and PII amplitude. The following parameters were significantly different between DCM patients with and without PH: S in V5 (SV5 ) > 10 mm, S in V6 (SV6 ) > 3 mm, R:S ratio in V5 (R:SV5 ) < 0.75, RV1  + SV5 or V6  > 10.5 mm, S > R inI, S > R inII and R:S V1  > R:S V3 , although results were no longer significant after correcting for multiple comparisons. High specificity (92.3-100%), lowsensitivity (31.8-50%), high positive predictive value, and low negative predictive value of established parameters of RVH were noted for predicting PH in patients with DCM.

Conclusion: Several ECG signs of RVH may be useful for in the diagnosis PH in patients with DCM.