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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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Kariki O, Karyofyllis P, Mililis P, Saplaouras A, Dragasis S, Chatziantoniou A, Alexiou D, Patsiotis IG, Letsas KP, Efremidis M. Electrocardiographic changes after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: Data from the Hellenic Registry. J Electrocardiol 2023; 81:26-31. [PMID: 37506539 DOI: 10.1016/j.jelectrocard.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Balloon pulmonary angioplasty (BPA) has provided an effective invasive treatment for inoperable patients with chronic thromboembolic pulmonary hypertension (CTEPH). The hemodynamic improvement achieved by BPA has significantly increased the long-term prognosis of these patients, mostly by reversing the negative remodeling of the right ventricle (RV). MATERIALS AND METHODS In a cohort of 17 patients with symptomatic CTEPH hemodynamic data were collected before and after the completion of BPA sessions. After the confirmation of statistically significant hemodynamic improvement, we examined the changes in certain prespecified electrocardiographic (ECG) parameters (PR interval duration, QRS duration, QTc interval duration, R wave and S wave amplitude in lead I, R wave and S wave amplitude in precordial leads V1, V5 and V6) before the initiation and one month after the completion of BPA sessions. In addition, ECGs were qualitatively assessed before and after treatment for the presence of ECG abnormalities related to PH, proposed by the guidelines of the European Society of Cardiology (ESC). The term ESC criteria 1-6 was used for their description. RESULTS Statistically significant correlation (p < 0.05) was found between the reduction in mean pulmonary artery pressure (mPAP) and the decrease of the depth of the S wave in leads I (p 0.0069), V5 (p 0.0003), V6 (p 0.0011) and in the R wave amplitude in leads V5 (p 0.0122) and V6 (p 0.0185). From the ESC criteria, RV strain pattern was the commonest in the initial cohort, with significant improvement after therapies. CONCLUSION Hemodynamic improvement after BPA therapies is correlated with improved ECG amplitude parameters in leads I, V5 and V6. RV strain pattern is common among untreated patients with significant improvement after therapies.
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Affiliation(s)
- Ourania Kariki
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Panagiotis Karyofyllis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Panagiotis Mililis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Athanasios Saplaouras
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Stylianos Dragasis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Anastasios Chatziantoniou
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Dimitris Alexiou
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Ilias G Patsiotis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Konstantinos P Letsas
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece.
| | - Michael Efremidis
- Division of Interventional Cardiology and Arrhythmia Unit, Onassis Cardiac Surgery Center, 17674 Athens, Greece
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