Piłka Michał, Darocha Szymon, Florczyk Michał, Mańczak Rafał, Banaszkiewicz Marta, Kędzierski Piotr, Zieliński Dariusz, Wróbel Krzysztof, Torbicki Adam, Kurzyna Marcin
Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland.
Cardiac Surgery Department, Medicover Hospital, 02-972 Warsaw, Poland.
J Clin Med. 2023 Dec 11;12(24):7621. doi: 10.3390/jcm12247621.
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.
The retrospective analysis included 73 patients who underwent PEA. Their ECG-PH index values were calculated using four ECG parameters: R-wave amplitude V + S-wave amplitude V/V > 10.5 mm, QRS-wave axis > 110 degrees, R-wave amplitude V > S-wave amplitude V, 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.
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.
The ECG-PH index may be useful for monitoring the haemodynamic effect of PEA in CTEPH patients.
心电图 - 肺动脉高压指数（PH - ECG评分）已被提出作为一种通过心电图评估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）疗效的有价值方法。肺动脉内膜剥脱术（PEA）是治疗近端有血栓的CTEPH的主要治疗方式。本研究的目的是评估静息心电图（心电图 - 肺动脉高压指数）在评估CTEPH患者PEA疗效中的临床应用价值。
回顾性分析纳入了73例行PEA的患者。使用四个心电图参数计算其心电图 - 肺动脉高压指数值：R波振幅V + S波振幅V/V > 10.5 mm、QRS波电轴> 110度、R波振幅V > S波振幅V以及SIQIII图形。自PEA手术起经过中位时间13个月（四分位间距：8 - 31个月）后评估PH - ECG评分。
当前分析表明，心电图 - 肺动脉高压指数 = 0很好地反映了PEA术后平均肺动脉压（mPAP）< 25 mmHg（敏感性76.1%；特异性66.7%；阳性预测值79.5%；阴性预测值62.1%）或mPAP≤20 mmHg（敏感性69.6%；特异性70.6%；阳性预测值88.6%；阴性预测值41.4%）。对于mPAP < 25 mmHg和mPAP≤20 mmHg患者组，心电图 - 肺动脉高压指数的ROC曲线下面积值分别为为0.772（95%置信区间：0.676 - 0.867）和0.743（95%置信区间：0.637 - 0.849）。
心电图 - 肺动脉高压指数可能有助于监测CTEPH患者PEA的血流动力学效应。
