The evolution of electrocardiographic signs of right ventricular overload after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Piłka, Michał; Darocha, Szymon; Banaszkiewicz, Marta; Florczyk, Michał; Wieteska, Maria; Dobosiewicz, Anna; Mańczak, Małgorzata; Mańczak, Rafał; Pietrasik, Arkadiusz; Pietura, Radosław; Torbicki, Adam; Kurzyna, Marcin

doi:10.20452/pamw.14877

Cited by 11 publications

(17 citation statements)

References 12 publications

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“…Few previous studies have assessed the relationship between surface ECG and CTEPH for diagnostic and prognostic purposes [13,14,[20][21][22]. To the best of our knowledge, this is the first study that aims to characterize RVH ECG signs in newly diagnosed CTEPH patients and to relate these parameters to the localization of thromboembolic material along with hemodynamic data.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is an unfulfilled need to develop simple noninvasive tools to help clinicians identify patients with a high probability of CTEPH. Some previous studies revealed that in patients with pulmonary hypertension, the right heart overload is associated with the occurrence of the specific electrocardiographic changes [13,14]. There is a paucity of data regarding the role of noninvasive electrocardiography (ECG) in CTEPH diagnosis, management, and prognosticating.…”

Section: Introductionmentioning

confidence: 99%

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Association of Electrocardiographic Signs of Right Ventricular Hypertrophy and Clot Localization in Chronic Thromboembolic Pulmonary Hypertension

Sławek-Szmyt

Araszkiewicz

Jankiewicz

et al. 2022

JCM

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The role of electrocardiography (ECG) in chronic thromboembolic pulmonary hypertension (CTEPH) diagnosis and prognosticating has not been yet established. We aimed to assess the relationships of the recommended ECG criteria of right ventricular hypertrophy (RVH) with clot localization in CTEPH patients. ECG patterns of RVH according to the American College of Cardiology Foundation were assessed in patients with newly diagnosed CTEPH. We enrolled 58 (45.3%) patients with proximal and 70 (54.7%) with distal CTEPH. Receiver-operating characteristics curves analysis indicated that the following ECG abnormalities predicted proximal CTEPH localization: RV1 > 6 mm—AUC 0.75 (CI: 0.66–0.84, p < 0.00001); SV6 > 3 mm—AUC 0.70 (CI: 0.60–0.79, p < 0.00001); SI > RI wave—AUC 0.67 (CI: 0.58–0.77, p = 0.0004); RV1:SV1 > 1.0—AUC 0.66 (CI: 0.56–0.76, p = 0.0009); RV1 peak > 0.035 s (QRS < 120 ms)—AUC 0.66 (CI: 0.56–0.75, p = 0.0016); RV1:SV1 > RV3(V4):SV3(V4)—AUC-0.65 (CI: 0.54–0.75, p = 0.0081); RaVR > 4 mm—AUC 0.62 (CI: 0.52–0.71, p = 0.002) and PII > 2.5 mm—AUC 0.62 (CI: 0.52–0.72, p = 0.00162). Pulmonary vascular resistance significantly correlated with amplitudes of RV1 (r = 0.34, p = 0.008), SV6 (r = 0.53, p = 0.000027) and PII (r = 0.44, p = 0.00007). In patients with CTEPH, only 8 out of 23 ECG RVH criteria were useful for differentiating between proximal and distal CTEPH localization and we found that RV1 and SV6 may contribute as potential discriminators.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association of Electrocardiographic Signs of Right Ventricular Hypertrophy and Clot Localization in Chronic Thromboembolic Pulmonary Hypertension

Sławek-Szmyt

Araszkiewicz

Jankiewicz

et al. 2022

JCM

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“…Some recent studies showed that unloading of the right ventricle in pulmonary hypertension can also improve several ECG parameters. In a study by Pilka et al, invasive treatment of CTEPH with balloon pulmonary angioplasty (BPA) was associated with a decrease in PVR and in mPAP, which was reflected by ECG improvement including a decrease in the frequency of negative T waves in leads V1–V3 from 55% before BPA to 22% after finishing BPA treatment [ 11 , 12 ]. Similar observations were found in a study by Nishiyama et al where negative T waves in V1–V3 were observed in 56% of patients before BPA and only in 8.3% after completing BPA treatment [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Extended Precordial T Wave Inversions Are Associated with Right Ventricular Enlargement and Poor Prognosis in Pulmonary Hypertension

Waligóra

Gliniak

Bylica

et al. 2021

JCM

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In pulmonary hypertension (PH), T wave inversions (TWI) are typically observed in precordial leads V1–V3 but can also extend further to the left-sided leads. To date, the cause and prognostic significance of this extension have not yet been assessed. Therefore, we aimed to assess the relationship between heart morphology and precordial TWI range, and the role of TWI in monitoring treatment efficacy and predicting survival. We retrospectively analyzed patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) treated in a reference pulmonary hypertension center. Patients were enrolled if they had a cardiac magnetic resonance (cMR) and 12-lead surface ECG performed at the time of assessment. They were followed from October 2008 until March 2021. We enrolled 77 patients with PAH and 56 patients with inoperable CTEPH. They were followed for a mean of 51 ± 33.5 months, and during this time 47 patients died (35.3%). Precordial TWI in V1–V6 were present in 42 (31.6%) patients, while no precordial TWI were observed only in 9 (6.8%) patients. The precordial TWI range correlated with markers of PH severity, including right ventricle to left ventricle volume RVEDVLVEDV (R = 0.76, p < 0.0001). The presence of TWI in consecutive leads from V1 to at least V5 predicted severe RV dilatation (RVEDVLVEDV ≥ 2.3) with a sensitivity of 88.9% and specificity of 84.1% (AUC of 0.90, 95% CI = 0.83–0.94, p < 0.0001). Presence of TWI from V1 to at least V5 was also a predictor of mortality in Kaplan–Meier estimation (p = 0.02). Presence of TWI from V1 to at least V5 had a specificity of 64.3%, sensitivity of 58.1%, negative predictive value of 75%, and positive predictive value of 45.5% as a mortality predictor. In patients showing a reduction in TWI range of at least one lead after treatment compared with patients without this reduction, we observed a significant improvement in RV-EDV and RV−EDVLV−EDV. We concluded that the extension of TWI to left-sided precordial leads reflects significant pathological alterations in heart geometry represented by an increase in RV/LV volume and predicts poor survival in patients with PAH and CTEPH. Additionally, we found that analysis of precordial TWI range can be used to monitor the effectiveness of hemodynamic response to treatment of pulmonary hypertension.

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“…Patients who complete the BPA therapy require periodic, non-invasive control, as well as RHC. In previous studies, it has been documented that BPA therapy and an improvement in haemodynamic parameters are associated with significant changes in the resting ECG [ 26 , 27 , 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the group of patients with an inferior response, there were no significant changes in the above parameters. In the whole analysed population, the percentage change in the PVR was significantly correlated with the percentage change in the values of the following ECG parameters: axis of the QRS (rho = 0.530) and T wave (rho = 0.372), P wave amplitude in leads II (rho = 0.340) and III (rho = 0.430), S wave amplitude in lead V 5 (rho = 0.634), R/S amplitude ratio in lead V 5 (rho = –0.636), S wave amplitude in lead V 6 (rho = 0.508), and S wave amplitude in lead I (rho = 0.496) [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Clinical Usefulness of Resting Electrocardiogram (PH-ECG Score) in Monitoring the Efficacy of Balloon Pulmonary Angioplasty (BPA) in Patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

Piłka¹,

Mańczak

Darocha³

et al. 2021

JCM

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Background: Balloon pulmonary angioplasty (BPA) is a form of therapy for chronic thromboembolic pulmonary hypertension (CTEPH). The study objective is to assess the clinical usefulness of resting ECG (PH-ECG score) in monitoring the efficacy of BPA in CTEPH patients. Methods and results: Ninety-four (n = 94) CTEPH patients were included in the analysis. A standard 12-lead-ECG was performed before the first BPA session and after completion of treatment. The whole analysed population (n = 94) was divided into the following two groups: derivation cohort (n = 41) and validation cohort (n = 53). The derivation cohort was divided into the following two subgroups: patients with mean pulmonary artery pressure (mPAP) after the completion of therapy < 25 mmHg (n = 21) and patients with mPAP after the completion of therapy ≥ 25 mmHg (n = 20). In the first subgroup, four (R-wave V1 + S-wave V5/V6 > 10.5mm, QRS-wave axis > 110degrees, R-wave V1 > S-wave V1, SIQIII pattern) of the six ECG parameters of overload of the right cardiac chambers showed statistically significant differences (p < 0.005). That was followed by a determination of the sensitivity and specificity, positive (PPV) and negative predictive value (NPV), and ROC curve (AUC 0.9; 95% CI: 0.792–1.000) for the variable that was a sum of the above four ECG parameters (PH-ECG score). The absence of all of the four ECG parameters at rest (PH-ECG score = 0) well reflected patients with mPAP < 25 mmHg (sensitivity, 100%; specificity, 80%; PPV, 84%; NPV, 100%). In the validation cohort with mPAP < 25 mmHg and PH-ECG score = 0, sensitivity, specificity, PPV, and NPV were 86%, 77%, 73%, and 89%, respectively. Conclusions: Resting ECG trace is clinically useful in the monitoring of therapeutical effects of BPA in CTEPH patients.

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The evolution of electrocardiographic signs of right ventricular overload after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

Cited by 11 publications

References 12 publications

Association of Electrocardiographic Signs of Right Ventricular Hypertrophy and Clot Localization in Chronic Thromboembolic Pulmonary Hypertension

Association of Electrocardiographic Signs of Right Ventricular Hypertrophy and Clot Localization in Chronic Thromboembolic Pulmonary Hypertension

Extended Precordial T Wave Inversions Are Associated with Right Ventricular Enlargement and Poor Prognosis in Pulmonary Hypertension

Assessment of Clinical Usefulness of Resting Electrocardiogram (PH-ECG Score) in Monitoring the Efficacy of Balloon Pulmonary Angioplasty (BPA) in Patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

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