Sławek-Szmyt Sylwia, Araszkiewicz Aleksander, Jankiewicz Stanisław, Smukowska-Gorynia Anna, Grygier Marek, Janus Magdalena, Lesiak Maciej, Mularek-Kubzdela Tatiana
1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland.
J Clin Med. 2022 Jan 26;11(3):625. doi: 10.3390/jcm11030625.
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: R > 6 mm-AUC 0.75 (CI: 0.66-0.84, < 0.00001); S > 3 mm-AUC 0.70 (CI: 0.60-0.79, < 0.00001); S > R wave-AUC 0.67 (CI: 0.58-0.77, = 0.0004); R:S > 1.0-AUC 0.66 (CI: 0.56-0.76, = 0.0009); R peak > 0.035 s (QRS < 120 ms)-AUC 0.66 (CI: 0.56-0.75, = 0.0016); R:S > R:SAUC-0.65 (CI: 0.54-0.75, = 0.0081); R > 4 mm-AUC 0.62 (CI: 0.52-0.71, = 0.002) and P > 2.5 mm-AUC 0.62 (CI: 0.52-0.72, = 0.00162). Pulmonary vascular resistance significantly correlated with amplitudes of R (r = 0.34, = 0.008), S (r = 0.53, = 0.000027) and P (r = 0.44, = 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 R and S may contribute as potential discriminators.
心电图（ECG）在慢性血栓栓塞性肺动脉高压（CTEPH）诊断及预后评估中的作用尚未明确。我们旨在评估CTEPH患者中推荐的右心室肥厚（RVH）心电图标准与血栓定位之间的关系。对新诊断的CTEPH患者，根据美国心脏病学基金会标准评估RVH的心电图模式。我们纳入了58例（45.3%）近端CTEPH患者和70例（54.7%）远端CTEPH患者。受试者工作特征曲线分析表明，以下心电图异常可预测近端CTEPH定位：R＞6mm-曲线下面积（AUC）0.75（95%置信区间：0.66-0.84，P＜0.00001）；S＞3mm-AUC 0.70（95%置信区间：0.60-0.79，P＜0.00001）；S＞R波-AUC 0.67（95%置信区间：0.58-0.77，P = 0.0004）；R∶S＞1.0-AUC 0.66（95%置信区间：0.56-0.76，P = 0.0009）；R峰＞0.035秒（QRS＜120毫秒）-AUC 0.66（95%置信区间：0.56-0.75，P = 0.0016）；R∶S＞R∶SAUC-0.65（95%置信区间：0.54-0.75，P = 0.0081）；R＞4mm-AUC 0.62（95%置信区间：0.52-0.71，P = 0.002）和P＞2.5mm-AUC 0.62（95%置信区间：0.52-0.72，P = 0.00162）。肺血管阻力与R波振幅（r = 0.34，P = 0.008）、S波振幅（r = 0.53，P = 0.000027）和P波振幅（r = 0.44，P = 0.00007）显著相关。在CTEPH患者中，23项心电图RVH标准中仅有8项可用于区分近端和远端CTEPH定位，我们发现R波和S波可能作为潜在的鉴别指标。
