Alterations in ECG and Right Heart Catheterization Data in PAH Patients Who Died From Sudden Death Compared With Right Heart Failure
Alexandra B. Flemington, Jeffery Annis, Evan L. Brittain, Anna R. Hemnes
https://doi.org/10.1002/pul2.70082
Abstract
A meaningful number of patients with PAH die suddenly, and there is little data to understand the events surrounding sudden death in PAH. We tested the hypothesis that sudden death is associated with pre-mortem ECG or hemodynamics changes compared to those who died of RHF. We extracted data from the Vanderbilt University Medical Center Synthetic Derivative. Patients 18 years of age and older with Group 1 PAH secondary to any etiology who died between 2009 and 2017 with both ECG and RHC data from the inpatient and outpatient setting were included in the study. Continuous variables were compared using the Wilcoxon rank-sum test while categorical variables were compared using the χ2 test. Logistic regression models, adjusted for age and sex, were then used to evaluate the association between death and specific ECG or RHC measurements. Comparing the final ECG before death, those who died of SD had significantly shorter terminal 40 ms interval of the QRS than those who died of RHF, which became nonsignificant when adjusted for age and sex. We observed differences in baseline RHC data between SD and RHF including higher RV systolic pressure which remained significant when adjusted for age and sex. Using this data, we hope to find clinical data that can be used to predict increased risk of sudden death and aid in stratifying Group I PAH patients to earlier and more aggressive interventions.