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. 2023 Dec 11;12(24):7621.
doi: 10.3390/jcm12247621.

The Utility of a Resting Electrocardiogram (ECG-PH Index) in Evaluating the Efficacy of Pulmonary Endarterectomy in Chronic Thromboembolic Pulmonary Hypertension

Michał Piłka  1 , Szymon Darocha  1 , Michał Florczyk  1 , Rafał Mańczak  1 , Marta Banaszkiewicz  1 , Piotr Kędzierski  1 , Dariusz Zieliński  2   3 , Krzysztof Wróbel  2   3 , Adam Torbicki  1 , Marcin Kurzyna  1
Affiliations

The Utility of a Resting Electrocardiogram (ECG-PH Index) in Evaluating the Efficacy of Pulmonary Endarterectomy in Chronic Thromboembolic Pulmonary Hypertension

Michał Piłka et al. J Clin Med. .

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.

Keywords: chronic thromboembolic pulmonary hypertension; electrocardiography; pulmonary endarterectomy; pulmonary hypertension.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Number of patients relative to the achieved mPAP.
Figure 2
Figure 2
Median (IQR) values of mean pulmonary artery pressure (mPAP) for the ECG-PH index.
Figure 3
Figure 3
ROC curve for the ECG-PH index in the group of patients with mean pulmonary artery pressure (mPAP) < 25 mmHg.
Figure 4
Figure 4
ROC curve for the ECG-PH index in the group of patients with mean pulmonary artery pressure (mPAP) ≤ 20 mmHg.
See this image and copyright information in PMC

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