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

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.

Analysis of Electrocardiographic Criteria of Right Ventricular Hypertrophy in Patients with Chronic Thromboembolic Pulmonary Hypertension before and after Balloon Pulmonary Angioplasty

“…This observed difference in prevalence could be due to the large proportion of patients with PAH, the poorer mean haemodynamics and thus the higher cardiac workload in Waligora’s study (PVR median in the present study: 536 dyn∗sec∗cm −5 ; PVR mean in Waligora et al: 1152 dyn∗sec∗cm −5 ) [ 24 ]. However, Slawek-Szmyt et al also found an “R/S V1 > R/S in V3, V4” in 75% of their cohort, although this CTEPH cohort had demographic and haemodynamic characteristics similar to those of the present one [ 38 ]. After BPA, the frequency of the occurrence of this parameter was reduced to 10% in this present study ( p < 0.001).…”

“…This is consistent with the results of Japanese researchers, in whose study none of the patients with CTEPH exceeded this cut-off value before or after BPA either [ 8 ]. Other studies reported a prevalence of 2–7% in PAH, CTEPH and IPAH [ 24 , 37 , 38 ]. Therefore, the assumption arises that the usefulness or the currently used cut-off value for this parameter is limited or not sensitive enough to support the diagnosis of PH.…”

“…The results of Waligora et al and Kopec et al in patients with PAH, CTEPH and IPAH supported these hypotheses (98% vs. 98%, p = 0.99; 96%) [ 24 , 37 ]. Slawek-Szmyt et al only reported 79% [ 38 ].…”

Prognostic Value of Pulmonary Artery Pulsatility Index in Right Ventricle Failure-Related Mortality in Inoperable Chronic Thromboembolic Pulmonary Hypertension

“…The detailed description of pulmonary angiography and CTPA procedures at our center have been previously published [ 21 ].…”

Emerging Role of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease—Insights from the 2022 ESC Guidelines

“…Additionally, electrocardiographic features of right ventricular hypertrophy (RVH) were analyzed in newly diagnosed CTEPH patients to differentiate between the distal and proximal clots localization. It was revealed that only 8 out of 23 ECG RVH criteria were useful for differentiating between proximal and distal CTEPH localization and RV1 and SV6 may contribute as potential discriminators [ 16 ].…”