Abstract
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.
Highlights
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, progressive pulmonary vascular disease characterized by persistent obstruction of the pulmonary arteries by organized thromboembolic material
In patients with CTEPH, only 8 out of 23 ECG right ventricular hypertrophy (RVH) criteria were useful for differentiating between proximal and distal CTEPH localization and we found that RV1 and SV6 may contribute as potential discriminators
The consecutive 128 patients with newly diagnosed CTEPH between November 2008 and November 2020 were enrolled in this study
Summary
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare, progressive pulmonary vascular disease characterized by persistent obstruction of the pulmonary arteries by organized thromboembolic material. The detailed pathophysiology of CTEPH remains unclear. A pulmonary endarterectomy (PEA) is the gold standard of treatment for operable patients. Some patients are ineligible for surgery due to distal localization of thromboembolic material and others who have undergone PEA suffered from persistent postoperative or recurrent pulmonary hypertension despite receiving optimal medical therapy [4]. Percutaneous balloon pulmonary angioplasty (BPA) has become a promising treatment modality for these CTEPH patients [5,6,7,8,9]. The efficacy of targeted medical treatment in CTEPH is limited [10,11]
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