ECG and Echocardiographic Findings in Adults with Chronic Pulmonary Disorders Who Use Electronic Cigarettes: A Meta-Analysis

Abstract

Background: Electronic-cigarette use is increasingly common among adults who currently smoke or have smoked combustible cigarettes, including people living with chronic obstructive pulmonary disease, asthma, bronchiectasis, interstitial lung disease, and chronic hypoxemic respiratory disorders. These patients often already have autonomic dysfunction, systemic inflammation, pulmonary vascular stress, right ventricular strain, myocardial ischemia, or other cardiovascular disease. Because electronic-cigarette aerosol can contain nicotine, ultrafine particles, carbonyl compounds, metals, and flavour-related chemicals, there are several plausible pathways through which vaping could affect cardiac rhythm and myocardial function. Yet the extent to which findings from existing human studies apply to adults with established chronic lung disease remains uncertain.

Objective: To critically evaluate human evidence on electrocardiographic, autonomic and echocardiographic findings associated with electronic-cigarette use, determine its applicability to adults with chronic pulmonary disorders, and identify clinically important evidence gaps.

Methods: A focused literature search of PubMed/MEDLINE was conducted from database inception through January, 2026. Search concepts included electronic cigarettes, vaping, electronic nicotine delivery systems, electrocardiography, QT interval, Tpeak–Tend interval, ventricular repolarization, arrhythmia, heart-rate variability, echocardiography, ventricular function, pulmonary hypertension, COPD, asthma, bronchiectasis and interstitial lung disease. Reference lists of relevant original investigations and scientific statements were examined. Adult human studies reporting ECG, autonomic, hemodynamic or echocardiographic outcomes after acute or habitual electronic-cigarette exposure were included. Because of substantial clinical and methodological heterogeneity, quantitative pooling was not performed.

Results: No prospective human study was identified that specifically recruited adults with an established chronic pulmonary disorder who regularly used electronic cigarettes and comprehensively evaluated predefined ECG and echocardiographic outcomes. Evidence from generally healthy electronic-cigarette users and combustible-cigarette smokers indicates that nicotine-containing vaping can acutely increase heart rate and blood pressure and shift cardiac autonomic balance toward sympathetic predominance. Several small studies reported prolongation of Tpeak–Tend, Tpeak–Tend/QT, Tpeak–Tend/QTc or QTc indices, although baseline and acute findings were inconsistent. A 2025 meta-analysis identified statistically higher repolarization indices in electronic-cigarette users, but it included only three heterogeneous studies and did not demonstrate increased clinical arrhythmia. Human echocardiographic evidence was limited predominantly to one acute study using an older-generation device. That investigation reported no significant immediate deterioration in measured left ventricular function after electronic-cigarette use, whereas combustible-cigarette smoking adversely affected several diastolic and myocardial performance indices. Evidence concerning right ventricular function, pulmonary artery pressure, ventricular strain, chronic cardiac remodeling, ambulatory arrhythmia burden or cardiovascular mortality in adults with chronic lung disease was absent or insufficient.

Conclusions: Electronic-cigarette use produces measurable acute autonomic and hemodynamic effects and may alter selected ECG repolarization indices. Nevertheless, the magnitude, persistence and clinical importance of these abnormalities in adults with chronic pulmonary disorders remain unknown. Existing  findings should not be interpreted as proof of clinically significant arrhythmia, pulmonary hypertension or ventricular dysfunction. Routine ECG or echocardiographic screening solely because of electronic-cigarette use is not currently supported. Cardiac investigation should be guided by symptoms, pulmonary disease severity, hypoxemia, cardiovascular risk and established clinical indications. Carefully designed prospective studies focusing on right ventricular–pulmonary vascular interactions and ambulatory rhythm outcomes are urgently required.