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Piłka M, Darocha S, Florczyk M, Mańczak R, Banaszkiewicz M, Kędzierski P, Zieliński D, Wróbel K, Torbicki A, Kurzyna M. The Utility of a Resting Electrocardiogram (ECG-PH Index) in Evaluating the Efficacy of Pulmonary Endarterectomy in Chronic Thromboembolic Pulmonary Hypertension. J Clin Med 2023; 12:7621. [PMID: 38137690 PMCID: PMC10743524 DOI: 10.3390/jcm12247621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The ECG-PH index (PH-ECG score) has been proposed as a valuable ECG-derived method of evaluating the effectiveness of balloon pulmonary angioplasty (BPA) in chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary endarterectomy (PEA) is the main form of therapy for CTEPH with a proximal clot location. The objective of this study was to assess the clinical utility of a resting electrocardiogram (ECG-PH index) in assessing the effectiveness of PEA in CTEPH patients. METHODS The retrospective analysis included 73 patients who underwent PEA. Their ECG-PH index values were calculated using four ECG parameters: R-wave amplitude V1 + S-wave amplitude V5/V6 > 10.5 mm, QRS-wave axis > 110 degrees, R-wave amplitude V1 > S-wave amplitude V1, and SIQIII pattern. PH-ECG scores were assessed after a median time of 13 months (IQR: 8-31 months) had passed since the PEA procedures. RESULTS The current analysis documented that ECG-PH index = 0 is a good reflection of mPAP < 25mmHg (sensitivity 76.1%; specificity 66.7%; positive predictive value 79.5%; negative predictive value 62.1%) or mPAP ≤ 20 mmHg (sensitivity 69.6%; specificity 70.6%; positive predictive value 88.6%; negative predictive value 41.4%) after PEA. The values of the area under the ROC curve for ECG-PH index were 0.772 (95% CI: 0.676-0.867) and 0.743 (95% CI: 0.637-0.849) for the mPAP < 25 mmHg and mPAP ≤ 20 mmHg patient groups, respectively. CONCLUSION The ECG-PH index may be useful for monitoring the haemodynamic effect of PEA in CTEPH patients.
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Affiliation(s)
- Michał Piłka
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Szymon Darocha
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Michał Florczyk
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Rafał Mańczak
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Marta Banaszkiewicz
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Piotr Kędzierski
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Dariusz Zieliński
- Cardiac Surgery Department, Medicover Hospital, 02-972 Warsaw, Poland; (D.Z.); (K.W.)
- Faculty of Medicine, Lazarski University, 02-662 Warsaw, Poland
| | - Krzysztof Wróbel
- Cardiac Surgery Department, Medicover Hospital, 02-972 Warsaw, Poland; (D.Z.); (K.W.)
- Faculty of Medicine, Lazarski University, 02-662 Warsaw, Poland
| | - Adam Torbicki
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Marcin Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
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