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Luijten, D.; Meijer, F.M.M.; Boon, G.J.A.M.; Ende-Verhaar, Y.M.; Bavalia, R.; Bouazzaoui, L.H. el; ... ; Klok, F.A. (2022)

Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism

Article / Letter to editor
Introduction: Application of the chronic thromboembolic pulmonary hypertension (CTEPH) rule out criteria (manual electrocardiogram [ECG] reading and N-terminal pro-brain natriuretic peptide [NTproBNP] test) can rule out CTEPH in pulmonary embolism (PE) patients with persistent dyspnea (InShape II algorithm). Increased pulmonary pressure may also be identified using automated ECG-derived ventricular gradient optimized for right ventricular pressure overload (VG-RVPO). Method: A predefined analysis of the InShape II study was performed. The diagnostic performance of the VG-RVPO for the detection of CTEPH and the incremental diagnostic value of the VG-RVPO as new rule-out criteria in the InShape II algorithm were evaluated. Results: 60 patients were included; 5 (8.3%) were ultimately diagnosed with CTEPH. The mean baseline VG-RVPO (at time of PE diagnosis) was -18.12 mV.ms for CTEPH patients and - 21.57 mV.ms for non-CTEPH patients (mean difference 3.46 mV.ms [95%CI -29.03 to 35.94]...Show moreIntroduction: Application of the chronic thromboembolic pulmonary hypertension (CTEPH) rule out criteria (manual electrocardiogram [ECG] reading and N-terminal pro-brain natriuretic peptide [NTproBNP] test) can rule out CTEPH in pulmonary embolism (PE) patients with persistent dyspnea (InShape II algorithm). Increased pulmonary pressure may also be identified using automated ECG-derived ventricular gradient optimized for right ventricular pressure overload (VG-RVPO). Method: A predefined analysis of the InShape II study was performed. The diagnostic performance of the VG-RVPO for the detection of CTEPH and the incremental diagnostic value of the VG-RVPO as new rule-out criteria in the InShape II algorithm were evaluated. Results: 60 patients were included; 5 (8.3%) were ultimately diagnosed with CTEPH. The mean baseline VG-RVPO (at time of PE diagnosis) was -18.12 mV.ms for CTEPH patients and - 21.57 mV.ms for non-CTEPH patients (mean difference 3.46 mV.ms [95%CI -29.03 to 35.94]). The VG-RVPO (after 3-6 months follow-up) normalized in patients with and without CTEPH, without a clear between-group difference (mean Delta VG-RVPO of -8.68 and - 8.42 mV.ms respectively; mean difference of -0.25 mV.ms, [95%CI -12.94 to 12.44]). The overall predictive accuracy of baseline VG-RVPO, follow-up RVPO and Delta VG-RVPO for CTEPH was moderate to poor (ROC AUC 0.611, 0.514 and 0.539, respectively). Up to 76% of the required echocardiograms could have been avoided with VG-RVPO criteria replacing the InShape II rule-out criteria, however at cost of missing up to 80% of the CTEPH diagnoses. Conclusion: We could not demonstrate (additional) diagnostic value of VG-RVPO as standalone test or as on top of the InShape II algorithm.Show less
Pulmonary hypertension
Algorithm
Pulmonary embolism
Vectorcardiography
Diagnosis
All authors
Luijten, D.; Meijer, F.M.M.; Boon, G.J.A.M.; Ende-Verhaar, Y.M.; Bavalia, R.; Bouazzaoui, L.H. el; Delcroix, M.; Huisman, M.V.; Mairuhu, A.T.A.; Middeldorp, S.; Pruszcyk, P.; Ruigrok, D.; Verhamme, P.; Noordegraaf, A.V.; Vriend, J.W.J.; Vliegen, H.W.; Klok, F.A.
Date
2022-09-01
Journal
Journal of Electrocardiology
Volume
74
Pages
94 - 100
DOI
doi:10.1016/j.jelectrocard.2022.08.007