Division of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, New York, New York.
Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York.
Am J Cardiol. 2023 Dec 1;208:60-64. doi: 10.1016/j.amjcard.2023.09.014. Epub 2023 Oct 10.
Cardiopulmonary exercise testing (CPET) is an important tool in assessing the functional status of patients with pulmonary arterial hypertension (PAH). During CPET, continuous electrocardiography (ECG) is used as a marker of exercise-induced ischemia or arrhythmia. We hypothesize that ECG changes with exercise may be an early indicator of clinical worsening in PAH and could predict adverse outcomes. Clinical, hemodynamic, and CPET data of 155 children and young adult patients with PAH who underwent CPET between 2012 and 2019 in our pulmonary hypertension (PH) center were included in this retrospective analysis. ECGs were analyzed for ST depressions and T-wave inversions, along with coincident hemodynamic data. These data were correlated with adverse outcomes divided into 2 categories: severe worsening (death or receiving lung transplant) and mild to moderate worsening (PAH medication escalation, hospitalization, shunt creation, or listing for lung transplant). The median age was 19 years (range 7 to 40 years), 69% were female, and the average follow-up time was 5 years (range 1 to 8 years). A total of 63 patients (41%) had at least 1 adverse outcome. A total of 39 patients (25%) demonstrated significant ST-T-wave changes with exercise. Patients with ST-T-wave changes were 20% more likely to die or need lung transplant than those without. The multiple linear regression found that ST-T-wave changes were a predictor of elevated mean pulmonary arterial pressure (mPAP) found on catheterization (R = 0.489, p = 0.003), although not of pulmonary vascular resistance index (R = -0.112, p = 0.484). An mPAP of 55 mm Hg was the most sensitive and specific point in identifying when ST-T-wave changes with exercise begin to appear. In conclusion, ST-T-wave changes on exercise ECG are significantly associated with adverse outcomes in PH in a medium-term follow-up study, and the presence of ST-T-wave changes correlates with higher mPAP. These ECG changes with exercise may be used as early indicators of clinical worsening in PH and predictors of adverse outcomes.
心肺运动测试 (CPET) 是评估肺动脉高压 (PAH) 患者功能状态的重要工具。在 CPET 期间，连续心电图 (ECG) 用作运动诱导缺血或心律失常的标志物。我们假设，运动时的心电图变化可能是 PAH 临床恶化的早期指标，并可预测不良结局。本回顾性分析纳入了 2012 年至 2019 年期间在我们的肺动脉高压 (PH) 中心接受 CPET 的 155 例儿童和青年 PAH 患者的临床、血流动力学和 CPET 数据。分析了心电图的 ST 段压低和 T 波倒置，以及同时的血流动力学数据。这些数据与分为 2 类的不良结局相关：严重恶化（死亡或接受肺移植）和轻度至中度恶化（PAH 药物升级、住院、分流创建或肺移植登记）。中位年龄为 19 岁（范围 7 至 40 岁），69%为女性，平均随访时间为 5 年（范围 1 至 8 年）。共有 63 例（41%）至少发生 1 次不良结局。共有 39 例（25%）患者在运动时出现明显的 ST-T 波改变。与无 ST-T 波改变的患者相比，有 ST-T 波改变的患者死亡或需要肺移植的可能性高 20%。多元线性回归发现，ST-T 波改变是导管插入术时平均肺动脉压 (mPAP) 升高的预测因子（R=0.489，p=0.003），尽管不是肺血管阻力指数 (R=0.112，p=0.484)。mPAP 为 55mmHg 时，是运动时出现 ST-T 波改变的最敏感和最特异的切点。总之，在一项中期随访研究中，运动心电图的 ST-T 波改变与 PH 的不良结局显著相关，ST-T 波改变的存在与更高的 mPAP 相关。这些运动时的心电图变化可用作 PH 临床恶化的早期指标，并预测不良结局。
