Vertical P-wave axis: The electrocardiographic synonym for pulmonary emphysema and its severity

Lovely Chhabra, Pooja Sareen, Daniel Perli, Indu Srinivasan, David H. Spodick

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations


Background: The correlation between vertical P-wave axis (P-axis > 60°) and pulmonary emphysema was investigated on a very large controlled series to see if P-axis verticalisation as lone criterion can be effectively used to screen emphysema in general population. Correlation between degrees of P-axis verticalisation and the severity of the obstructive lung disease (as per global initiative for chronic obstructive lung disease [GOLD] criteria) was also studied to see if this criterion can be used for gross quantification of the chronic obstructive pulmonary disease (COPD) in routine clinical practice. Materials and methods: Around 6500 unselected, routine electrocardiograms (ECGs) were reviewed which yielded 600 ECGs with vertical P-axis in sinus rhythm. 635 ECGs from the same continuum were selected with P-axis ≤60° matched for patient's age and sex serving as controls. Charts were reviewed for the diagnosis of COPD and emphysema based on medical history, pulmonary function tests, and imaging studies. Results: Prevalence of emphysema in patients with vertical P-axis was strikingly higher than in the control group: 85% vs 4.4%. The sensitivity and specificity of vertical P-axis for diagnosing emphysema was 94.76% and 86.47%, respectively. Vertical P-axis and forced expiratory volume (FEV1) were inversely correlated (Pearson correlation coefficient = -0.683). Prevalence of severe COPD was strikingly higher in patients with P-axis > 75° as compared to the group with P-axis 60°-75°: 96.3% vs 4.6%. Close to 80% of the emphysema patients with P-axis > 85° had very severe disease (FEV1 < 30%). Conclusion: P-axis verticalisation is highly effective for screening emphysema and degree of verticalisation provides a gross quantification of the disease.

Original languageEnglish (US)
Pages (from-to)40-42
Number of pages3
JournalIndian heart journal
Issue number1
StatePublished - 2012
Externally publishedYes


  • Chronic obstructive lung disease
  • Electrocardiogram (ECG)
  • Pulmonary emphysema
  • Pulmonary function test


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