Electrocardiographic screening for obstructive lung disease

Value of frontal plane P wave axis

Raj Baljepally, D. H. Spodick

Research output: Contribution to journalArticle

Abstract

Purpose: Characteristic electrocardiographic effects of emphysema are long known, particularly verticalization of frontal plane P wave axis. Frequency of P vector verticalization led us to consider P wave axis as a screening test for obstructive lung disease (OLD). Methods: We chose a vertical P wave axis (+70°±90°) as a single screening criterion in an investigation of 200 consecutive adult (mean age = 63 years, % male = 52) electrocardiograms (ECG's). We screened 924 ECG's and selected 100 consecutive ECG's with a vertical P wave axis of ≥70° and a second 100 consecutive ECG's with a P wave axis of ≤50°. ECG's with poor quality data, atrial fibrillation, other atrial arrhythmia's, and patients with insufficiently documented diagnoses were excluded. A careful review of patient records was performed looking for presence or absence of documentation of OLD. This was then verified by either a history of chronic steroid/ home oxygen use for OLD or hyperinflated lungs on chest roentgenogram and/or pulmonary function tests suggesting OLD. Results: Vertical P Axis Obstructive Lung Disease (OLD) Present Absent Present (n=100) 89 11 Absent (n=100) 4 96 Sensitivity=96%, specificity=90%, positive predictive value=89%, negative predictive value=96%. Conclusion: Vertical P wave axis is an effective screening test for OLD. Clinical Implications: By disclosing verticalization of P wave axis, the standard ECG is a useful inexpensive tool to screen adult patients for obstructive lung disease.

Original languageEnglish (US)
JournalChest
Volume110
Issue number4 SUPPL.
StatePublished - Oct 1 1996
Externally publishedYes

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Obstructive Lung Diseases
Electrocardiography
Respiratory Function Tests
Emphysema
Documentation
Atrial Fibrillation
Cardiac Arrhythmias
Thorax
Steroids
Oxygen
Sensitivity and Specificity
Lung

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Electrocardiographic screening for obstructive lung disease : Value of frontal plane P wave axis. / Baljepally, Raj; Spodick, D. H.

In: Chest, Vol. 110, No. 4 SUPPL., 01.10.1996.

Research output: Contribution to journalArticle

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abstract = "Purpose: Characteristic electrocardiographic effects of emphysema are long known, particularly verticalization of frontal plane P wave axis. Frequency of P vector verticalization led us to consider P wave axis as a screening test for obstructive lung disease (OLD). Methods: We chose a vertical P wave axis (+70°±90°) as a single screening criterion in an investigation of 200 consecutive adult (mean age = 63 years, {\%} male = 52) electrocardiograms (ECG's). We screened 924 ECG's and selected 100 consecutive ECG's with a vertical P wave axis of ≥70° and a second 100 consecutive ECG's with a P wave axis of ≤50°. ECG's with poor quality data, atrial fibrillation, other atrial arrhythmia's, and patients with insufficiently documented diagnoses were excluded. A careful review of patient records was performed looking for presence or absence of documentation of OLD. This was then verified by either a history of chronic steroid/ home oxygen use for OLD or hyperinflated lungs on chest roentgenogram and/or pulmonary function tests suggesting OLD. Results: Vertical P Axis Obstructive Lung Disease (OLD) Present Absent Present (n=100) 89 11 Absent (n=100) 4 96 Sensitivity=96{\%}, specificity=90{\%}, positive predictive value=89{\%}, negative predictive value=96{\%}. Conclusion: Vertical P wave axis is an effective screening test for OLD. Clinical Implications: By disclosing verticalization of P wave axis, the standard ECG is a useful inexpensive tool to screen adult patients for obstructive lung disease.",
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