静息心电图（PH-ECG评分）在监测慢性血栓栓塞性肺动脉高压（CTEPH）患者球囊肺动脉血管成形术（BPA）疗效中的临床实用性评估
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).
作者信息
Piłka Michał, Mańczak Małgorzata, Darocha Szymon, Banaszkiewicz Marta, Mańczak Rafał, Florczyk Michał, Kędzierski Piotr, Pietrasik Arkadiusz, Balsam Paweł, Kurzyna Paweł, Wasilewski Marcin, Wolański Rafał, Torbicki Adam, Kurzyna Marcin
机构信息
Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre Otwock, 05-400 Otwock, Poland.
Department of Gerontology, Public Health and Didactics National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland.
出版信息
J Clin Med. 2021 Sep 30;10(19):4548. doi: 10.3390/jcm10194548.
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 ( = 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 ( = 94) was divided into the following two groups: derivation cohort ( = 41) and validation cohort ( = 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 ( = 21) and patients with mPAP after the completion of therapy ≥ 25 mmHg ( = 20). In the first subgroup, four (R-wave V1 + S-wave V5/V6 > 10.5 mm, QRS-wave axis > 110 degrees, R-wave V1 > S-wave V1, SIQIII pattern) of the six ECG parameters of overload of the right cardiac chambers showed statistically significant differences ( < 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.
背景
球囊肺动脉血管成形术（BPA）是治疗慢性血栓栓塞性肺动脉高压（CTEPH）的一种治疗方式。本研究的目的是评估静息心电图（PH-ECG评分）在监测CTEPH患者BPA疗效方面的临床实用性。
方法与结果
94例CTEPH患者纳入分析。在首次BPA治疗前及治疗结束后进行标准12导联心电图检查。将整个分析人群（n = 94）分为以下两组：推导队列（n = 41）和验证队列（n = 53）。推导队列又分为以下两个亚组：治疗结束后平均肺动脉压（mPAP）<25 mmHg的患者（n = 21）和治疗结束后mPAP≥25 mmHg的患者（n = 20）。在第一个亚组中，右心腔负荷过重的六个心电图参数中的四个（V1导联R波+V5/V6导联S波>10.5 mm、QRS波电轴>110度、V1导联R波>S波、SIQIII图形）显示出统计学显著差异（P<0.005）。随后确定上述四个心电图参数之和（PH-ECG评分）这一变量的敏感性和特异性、阳性预测值（PPV）和阴性预测值（NPV）以及ROC曲线（AUC 0.9；95%CI：0.792 - 1.000）。静息时所有四个心电图参数均不存在（PH-ECG评分 = 0）能很好地反映mPAP<25 mmHg的患者（敏感性100%；特异性80%；PPV 84%；NPV 100%）。在mPAP<25 mmHg且PH-ECG评分 = 0的验证队列中，敏感性、特异性、PPV和NPV分别为86%、77%、73%和89%。
结论
静息心电图对监测CTEPH患者BPA的治疗效果具有临床实用性。
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