Evaluations of vertical P‐wave axis in the diagnosis of emphysema and assessment of its severity
Background: Emphysema is chronic obstructive pulmonary disease that result in an abnormal permanent enlargement of air spaces distal to the terminal bronchioles. This leads to presence of increased air between the heart and the ECG recording electrodes that may alter ECG findings in patient with emphysema. Aims: To evaluate the vertical P‐wave axis in the diagnosis of emphysema and assessment of its severity. Patients and Methods: This is a case ‐ control study conducted at Al Yarmouk Teaching Hospital and The Medical City in Baghdad during the period from the 1 st of February 2012 to 31 st of January 2013. A total of 100 emphysematous patients compared with other well matched 100 non emphysematous patients as a control group. The diagnosis of pulmonary emphysema was based on clinical history , physical examination , chest radiographs finding, High resolution chest CT scan and pulmonary function test. Full history including age, sex, occupation, history of smoking was taken and complete physical examination was done on both groups, ECG and PFT done for all emphysema patient and control group and P‐wave axis calculated. Results: Demographic characteristics of emphysema patients & non emphysema controls were comparable apart from significant association between smoking and emphysema (P < 0.001). Our emphysematous patients show that mean P‐wave axis were signiﬁcantly (P < 0.01) higher than that of control group. There is 86% of emphysema patient with vertical (>60 °) P‐wave axis in comparison to 9% of control group.There is a signiﬁcant inverse correlation between P wave axis and FEV1 that decrease in FEV1 is associated with increase in P wave axis and vice versa. Those with FEV1 less than 50% signiﬁcantly have higher P wave axis mean Conclusions: This study revealed clearly that p‐wave axis deviation to the right is the most characteristic ECG change that occur in emphysema. Moreover, There is a significant inverse correlation between P wave axis and FEV1.