Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism

Dieuwke Luijten; Fleur M M Meijer; Gudula J A M Boon; Yvonne M Ende-Verhaar; Roisin Bavalia; Lahassan H El Bouazzaoui; Marion Delcroix; Menno V Huisman; Albert T A Mairuhu; Saskia Middeldorp; Piotr Pruszcyk; Dieuwertje Ruigrok; Peter Verhamme; Anton Vonk Noordegraaf; Joris W J Vriend; Hubert W Vliegen; Frederikus A Klok

doi:10.1016/j.jelectrocard.2022.08.007

Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism

Dieuwke Luijten, Fleur M M Meijer, Gudula J A M Boon, Yvonne M Ende-Verhaar, Roisin Bavalia, Lahassan H El Bouazzaoui, Marion Delcroix, Menno V Huisman, Albert T A Mairuhu, Saskia Middeldorp, Piotr Pruszcyk, Dieuwertje Ruigrok, Peter Verhamme, Anton Vonk Noordegraaf, Joris W J Vriend, Hubert W Vliegen, Frederikus A Klok

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

INTRODUCTION: Application of the chronic thromboembolic pulmonary hypertension (CTEPH) rule out criteria (manual electrocardiogram [ECG] reading and N-terminal pro-brain natriuretic peptide [NTproBNP] test) can rule out CTEPH in pulmonary embolism (PE) patients with persistent dyspnea (InShape II algorithm). Increased pulmonary pressure may also be identified using automated ECG-derived ventricular gradient optimized for right ventricular pressure overload (VG-RVPO).

METHOD: A predefined analysis of the InShape II study was performed. The diagnostic performance of the VG-RVPO for the detection of CTEPH and the incremental diagnostic value of the VG-RVPO as new rule-out criteria in the InShape II algorithm were evaluated.

RESULTS: 60 patients were included; 5 (8.3%) were ultimately diagnosed with CTEPH. The mean baseline VG-RVPO (at time of PE diagnosis) was -18.12 mV·ms for CTEPH patients and - 21.57 mV·ms for non-CTEPH patients (mean difference 3.46 mV·ms [95%CI -29.03 to 35.94]). The VG-RVPO (after 3-6 months follow-up) normalized in patients with and without CTEPH, without a clear between-group difference (mean Δ VG-RVPO of -8.68 and - 8.42 mV·ms respectively; mean difference of -0.25 mV·ms, [95%CI -12.94 to 12.44]). The overall predictive accuracy of baseline VG-RVPO, follow-up RVPO and Δ VG-RVPO for CTEPH was moderate to poor (ROC AUC 0.611, 0.514 and 0.539, respectively). Up to 76% of the required echocardiograms could have been avoided with VG-RVPO criteria replacing the InShape II rule-out criteria, however at cost of missing up to 80% of the CTEPH diagnoses.

CONCLUSION: We could not demonstrate (additional) diagnostic value of VG-RVPO as standalone test or as on top of the InShape II algorithm.

Original language	English
Pages (from-to)	94-100
Number of pages	7
Journal	Journal of Electrocardiology
Volume	74
DOIs	https://doi.org/10.1016/j.jelectrocard.2022.08.007
Publication status	Published - 2022
Externally published	Yes

Keywords

Electrocardiography
Humans
Hypertension, Pulmonary/complications
Pulmonary Embolism/complications

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10.1016/j.jelectrocard.2022.08.007

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Luijten, D., Meijer, F. M. M., Boon, G. J. A. M., Ende-Verhaar, Y. M., Bavalia, R., El Bouazzaoui, L. H., Delcroix, M., Huisman, M. V., Mairuhu, A. T. A., Middeldorp, S., Pruszcyk, P., Ruigrok, D., Verhamme, P., Vonk Noordegraaf, A., Vriend, J. W. J., Vliegen, H. W., & Klok, F. A. (2022). Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism. Journal of Electrocardiology, 74, 94-100. https://doi.org/10.1016/j.jelectrocard.2022.08.007

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title = "Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism",

abstract = "INTRODUCTION: Application of the chronic thromboembolic pulmonary hypertension (CTEPH) rule out criteria (manual electrocardiogram [ECG] reading and N-terminal pro-brain natriuretic peptide [NTproBNP] test) can rule out CTEPH in pulmonary embolism (PE) patients with persistent dyspnea (InShape II algorithm). Increased pulmonary pressure may also be identified using automated ECG-derived ventricular gradient optimized for right ventricular pressure overload (VG-RVPO).METHOD: A predefined analysis of the InShape II study was performed. The diagnostic performance of the VG-RVPO for the detection of CTEPH and the incremental diagnostic value of the VG-RVPO as new rule-out criteria in the InShape II algorithm were evaluated.RESULTS: 60 patients were included; 5 (8.3%) were ultimately diagnosed with CTEPH. The mean baseline VG-RVPO (at time of PE diagnosis) was -18.12 mV·ms for CTEPH patients and - 21.57 mV·ms for non-CTEPH patients (mean difference 3.46 mV·ms [95%CI -29.03 to 35.94]). The VG-RVPO (after 3-6 months follow-up) normalized in patients with and without CTEPH, without a clear between-group difference (mean Δ VG-RVPO of -8.68 and - 8.42 mV·ms respectively; mean difference of -0.25 mV·ms, [95%CI -12.94 to 12.44]). The overall predictive accuracy of baseline VG-RVPO, follow-up RVPO and Δ VG-RVPO for CTEPH was moderate to poor (ROC AUC 0.611, 0.514 and 0.539, respectively). Up to 76% of the required echocardiograms could have been avoided with VG-RVPO criteria replacing the InShape II rule-out criteria, however at cost of missing up to 80% of the CTEPH diagnoses.CONCLUSION: We could not demonstrate (additional) diagnostic value of VG-RVPO as standalone test or as on top of the InShape II algorithm.",

keywords = "Electrocardiography, Humans, Hypertension, Pulmonary/complications, Pulmonary Embolism/complications",

author = "Dieuwke Luijten and Meijer, {Fleur M M} and Boon, {Gudula J A M} and Ende-Verhaar, {Yvonne M} and Roisin Bavalia and {El Bouazzaoui}, {Lahassan H} and Marion Delcroix and Huisman, {Menno V} and Mairuhu, {Albert T A} and Saskia Middeldorp and Piotr Pruszcyk and Dieuwertje Ruigrok and Peter Verhamme and {Vonk Noordegraaf}, Anton and Vriend, {Joris W J} and Vliegen, {Hubert W} and Klok, {Frederikus A}",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors",

year = "2022",

doi = "10.1016/j.jelectrocard.2022.08.007",

language = "English",

volume = "74",

pages = "94--100",

journal = "Journal of Electrocardiology",

issn = "0022-0736",

publisher = "Churchill Livingstone",

}

Luijten, D, Meijer, FMM, Boon, GJAM, Ende-Verhaar, YM, Bavalia, R, El Bouazzaoui, LH, Delcroix, M, Huisman, MV, Mairuhu, ATA, Middeldorp, S, Pruszcyk, P, Ruigrok, D, Verhamme, P, Vonk Noordegraaf, A, Vriend, JWJ, Vliegen, HW & Klok, FA 2022, 'Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism', Journal of Electrocardiology, vol. 74, pp. 94-100. https://doi.org/10.1016/j.jelectrocard.2022.08.007

Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism. / Luijten, Dieuwke; Meijer, Fleur M M; Boon, Gudula J A M et al.
In: Journal of Electrocardiology, Vol. 74, 2022, p. 94-100.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism

AU - Luijten, Dieuwke

AU - Meijer, Fleur M M

AU - Boon, Gudula J A M

AU - Ende-Verhaar, Yvonne M

AU - Bavalia, Roisin

AU - El Bouazzaoui, Lahassan H

AU - Delcroix, Marion

AU - Huisman, Menno V

AU - Mairuhu, Albert T A

AU - Middeldorp, Saskia

AU - Pruszcyk, Piotr

AU - Ruigrok, Dieuwertje

AU - Verhamme, Peter

AU - Vonk Noordegraaf, Anton

AU - Vriend, Joris W J

AU - Vliegen, Hubert W

AU - Klok, Frederikus A

PY - 2022

Y1 - 2022

N2 - INTRODUCTION: Application of the chronic thromboembolic pulmonary hypertension (CTEPH) rule out criteria (manual electrocardiogram [ECG] reading and N-terminal pro-brain natriuretic peptide [NTproBNP] test) can rule out CTEPH in pulmonary embolism (PE) patients with persistent dyspnea (InShape II algorithm). Increased pulmonary pressure may also be identified using automated ECG-derived ventricular gradient optimized for right ventricular pressure overload (VG-RVPO).METHOD: A predefined analysis of the InShape II study was performed. The diagnostic performance of the VG-RVPO for the detection of CTEPH and the incremental diagnostic value of the VG-RVPO as new rule-out criteria in the InShape II algorithm were evaluated.RESULTS: 60 patients were included; 5 (8.3%) were ultimately diagnosed with CTEPH. The mean baseline VG-RVPO (at time of PE diagnosis) was -18.12 mV·ms for CTEPH patients and - 21.57 mV·ms for non-CTEPH patients (mean difference 3.46 mV·ms [95%CI -29.03 to 35.94]). The VG-RVPO (after 3-6 months follow-up) normalized in patients with and without CTEPH, without a clear between-group difference (mean Δ VG-RVPO of -8.68 and - 8.42 mV·ms respectively; mean difference of -0.25 mV·ms, [95%CI -12.94 to 12.44]). The overall predictive accuracy of baseline VG-RVPO, follow-up RVPO and Δ VG-RVPO for CTEPH was moderate to poor (ROC AUC 0.611, 0.514 and 0.539, respectively). Up to 76% of the required echocardiograms could have been avoided with VG-RVPO criteria replacing the InShape II rule-out criteria, however at cost of missing up to 80% of the CTEPH diagnoses.CONCLUSION: We could not demonstrate (additional) diagnostic value of VG-RVPO as standalone test or as on top of the InShape II algorithm.

AB - INTRODUCTION: Application of the chronic thromboembolic pulmonary hypertension (CTEPH) rule out criteria (manual electrocardiogram [ECG] reading and N-terminal pro-brain natriuretic peptide [NTproBNP] test) can rule out CTEPH in pulmonary embolism (PE) patients with persistent dyspnea (InShape II algorithm). Increased pulmonary pressure may also be identified using automated ECG-derived ventricular gradient optimized for right ventricular pressure overload (VG-RVPO).METHOD: A predefined analysis of the InShape II study was performed. The diagnostic performance of the VG-RVPO for the detection of CTEPH and the incremental diagnostic value of the VG-RVPO as new rule-out criteria in the InShape II algorithm were evaluated.RESULTS: 60 patients were included; 5 (8.3%) were ultimately diagnosed with CTEPH. The mean baseline VG-RVPO (at time of PE diagnosis) was -18.12 mV·ms for CTEPH patients and - 21.57 mV·ms for non-CTEPH patients (mean difference 3.46 mV·ms [95%CI -29.03 to 35.94]). The VG-RVPO (after 3-6 months follow-up) normalized in patients with and without CTEPH, without a clear between-group difference (mean Δ VG-RVPO of -8.68 and - 8.42 mV·ms respectively; mean difference of -0.25 mV·ms, [95%CI -12.94 to 12.44]). The overall predictive accuracy of baseline VG-RVPO, follow-up RVPO and Δ VG-RVPO for CTEPH was moderate to poor (ROC AUC 0.611, 0.514 and 0.539, respectively). Up to 76% of the required echocardiograms could have been avoided with VG-RVPO criteria replacing the InShape II rule-out criteria, however at cost of missing up to 80% of the CTEPH diagnoses.CONCLUSION: We could not demonstrate (additional) diagnostic value of VG-RVPO as standalone test or as on top of the InShape II algorithm.

KW - Electrocardiography

KW - Humans

KW - Hypertension, Pulmonary/complications

KW - Pulmonary Embolism/complications

U2 - 10.1016/j.jelectrocard.2022.08.007

DO - 10.1016/j.jelectrocard.2022.08.007

M3 - Article

C2 - 36057190

SN - 0022-0736

VL - 74

SP - 94

EP - 100

JO - Journal of Electrocardiology

JF - Journal of Electrocardiology

ER -

Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism

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Keywords

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