Electrocardiographic abnormalities in patients with pericardial disease--Association of PR segment depression with arrhythmias and clinical signs: Experience of cardiac surgery center.

Objective: We aimed to describe clinical, morphological, intraoperative, echocardiographic and electrocardiographic (ECG) associations of PR segment depression (PRsd), as well as its relationship with arrhythmias and outcomes in pericardial diseases (PD).

Methods: Overall, 79 patients among 197 patients with PD, referred to cardiac surgery center for treatment, were eligible for inclusion in the study. ECGs were analyzed for presence of PRsd, abnormal P-wave, low voltage QRS, QRS alternans, STj deviation and arrhythmias. We analyzed patients' clinical, echocardiographic and intraoperative data, as well as arrhythmias and outcomes (death, rehospitalization, heart failure).

Results: Overall 45.5% of patients with PD had signs of PRsd. PRsd was associated with elevated markers of inflammation, purulent content of pericardial fluid, extent of effusion and pericardial calcification, signs of constriction and tamponade. We also observed significant association of PRsd with ECG abnormalities--STj changes, notched P-wave, low voltage QRS and QRS alternans, as well as arrhythmias. Overall, 30.6% of patients with PRsd had unfavorable composite outcome as compared to 7% in patients without PRsd (p=0.006). Logistic regression analysis results demonstrated compression (tamponade or constriction) (OR 14.93, 95% CI 2.71-82.0, p=0.002), inflammation (OR -11.42, 95% CI 2.16-60.35, p=0.004) and notched P-wave (OR -5.27, 95% CI 1.32-20.99, p=0.018) as independent predictors of PRsd. The model allowed predicting presence of PRsd in 80% of cases.

Conclusions: PRsd in patients with PD is associated with signs of inflammation, diffuse effusion and calcification, and compression (tamponade and constriction), arrhythmias and unfavorable outcomes. The independent predictors of PR segment depression are signs of compression, inflammation and notched P-wave.