Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism
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). Incr...
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| Veröffentlicht in: | Journal of electrocardiology 2022-09, Vol.74, p.94-100 |
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| creator | Luijten, Dieuwke Meijer, Fleur M.M. Boon, Gudula J.A.M. Ende-Verhaar, Yvonne M. Bavalia, Roisin El Bouazzaoui, Lahassan H. Delcroix, Marion Huisman, Menno V. Mairuhu, Albert T.A. Middeldorp, Saskia Pruszcyk, Piotr Ruigrok, Dieuwertje Verhamme, Peter Vonk Noordegraaf, Anton Vriend, Joris W.J. Vliegen, Hubert W. Klok, Frederikus A. |
| description | 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).
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.
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.
We could not demonstrate (additional) diagnostic value of VG-RVPO as standalone test or as on top of the InShape II algorithm.
•The VG-RVPO improved over time after acute PE for CTEPH and non-CTEPH patients.•The VG-RVPO as a standalone test does not accurately discriminate CTEPH from non-CTEPH patients.•Additional diagnostic value of VG-RVPO on top of the InShape II algorithm could not be shown.•Our findings should be regarded as hypothesis generating due to low sample size. |
| doi_str_mv | 10.1016/j.jelectrocard.2022.08.007 |
| format | Article |
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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.
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.
We could not demonstrate (additional) diagnostic value of VG-RVPO as standalone test or as on top of the InShape II algorithm.
•The VG-RVPO improved over time after acute PE for CTEPH and non-CTEPH patients.•The VG-RVPO as a standalone test does not accurately discriminate CTEPH from non-CTEPH patients.•Additional diagnostic value of VG-RVPO on top of the InShape II algorithm could not be shown.•Our findings should be regarded as hypothesis generating due to low sample size.</description><identifier>ISSN: 0022-0736</identifier><identifier>EISSN: 1532-8430</identifier><identifier>DOI: 10.1016/j.jelectrocard.2022.08.007</identifier><identifier>PMID: 36057190</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Algorithm ; Diagnosis ; Electrocardiography ; Humans ; Hypertension, Pulmonary - complications ; Hypertension, Pulmonary - diagnosis ; Pulmonary embolism ; Pulmonary Embolism - complications ; Pulmonary Embolism - diagnosis ; Pulmonary hypertension ; Vectorcardiography</subject><ispartof>Journal of electrocardiology, 2022-09, Vol.74, p.94-100</ispartof><rights>2022 The Authors</rights><rights>Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c432t-dc0ab31fcd6413de3b2de4a1f50abd6634fb5618a81efd975b7eab58447be6133</citedby><cites>FETCH-LOGICAL-c432t-dc0ab31fcd6413de3b2de4a1f50abd6634fb5618a81efd975b7eab58447be6133</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jelectrocard.2022.08.007$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36057190$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Luijten, Dieuwke</creatorcontrib><creatorcontrib>Meijer, Fleur M.M.</creatorcontrib><creatorcontrib>Boon, Gudula J.A.M.</creatorcontrib><creatorcontrib>Ende-Verhaar, Yvonne M.</creatorcontrib><creatorcontrib>Bavalia, Roisin</creatorcontrib><creatorcontrib>El Bouazzaoui, Lahassan H.</creatorcontrib><creatorcontrib>Delcroix, Marion</creatorcontrib><creatorcontrib>Huisman, Menno V.</creatorcontrib><creatorcontrib>Mairuhu, Albert T.A.</creatorcontrib><creatorcontrib>Middeldorp, Saskia</creatorcontrib><creatorcontrib>Pruszcyk, Piotr</creatorcontrib><creatorcontrib>Ruigrok, Dieuwertje</creatorcontrib><creatorcontrib>Verhamme, Peter</creatorcontrib><creatorcontrib>Vonk Noordegraaf, Anton</creatorcontrib><creatorcontrib>Vriend, Joris W.J.</creatorcontrib><creatorcontrib>Vliegen, Hubert W.</creatorcontrib><creatorcontrib>Klok, Frederikus A.</creatorcontrib><title>Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism</title><title>Journal of electrocardiology</title><addtitle>J Electrocardiol</addtitle><description>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).
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.
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.
We could not demonstrate (additional) diagnostic value of VG-RVPO as standalone test or as on top of the InShape II algorithm.
•The VG-RVPO improved over time after acute PE for CTEPH and non-CTEPH patients.•The VG-RVPO as a standalone test does not accurately discriminate CTEPH from non-CTEPH patients.•Additional diagnostic value of VG-RVPO on top of the InShape II algorithm could not be shown.•Our findings should be regarded as hypothesis generating due to low sample size.</description><subject>Algorithm</subject><subject>Diagnosis</subject><subject>Electrocardiography</subject><subject>Humans</subject><subject>Hypertension, Pulmonary - complications</subject><subject>Hypertension, Pulmonary - diagnosis</subject><subject>Pulmonary embolism</subject><subject>Pulmonary Embolism - complications</subject><subject>Pulmonary Embolism - diagnosis</subject><subject>Pulmonary hypertension</subject><subject>Vectorcardiography</subject><issn>0022-0736</issn><issn>1532-8430</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUU1v1DAQtSpQuxT-ArI4cUkYx0mc5Ya2HyBV4gJny7HHXa-SONjOov0__NA62oJ65DAajee9N-N5hHxgUDJg7adDecABdQpeq2DKCqqqhK4EEBdkwxpeFV3N4RXZQO4UIHh7Rd7EeACAbSWqS3LFW2gE28KG_Llx6nHyMTlN0VqnlT5Rb-nt7r4wGNwRDT3ilILTy6ACfQzKuFxT6wNNe6QGU17F-Wll6X3wU1ZKOY-9xxxDLudlGP2kwonuTzOGhFNcCW6is0qrWqS_XdpTpZeEL9BnfhzfktdWDRHfPedr8vPu9sfua_Hw_f7b7stDoWtepcJoUD1nVpu2Ztwg7yuDtWK2ye-mbXlt-6ZlneoYWrMVTS9Q9U1X16LHlnF-TT6edefgfy0Ykxxd1DgMakK_RFkJ2Io6H3GFfj5DdfAxBrRyDm7MS0sGcnVJHuRLl-TqkoROZpcy-f3znKUf0fyj_rUlA27OAMy_PToMMup8J43GhSwpjXf_M-cJmhGwRw</recordid><startdate>202209</startdate><enddate>202209</enddate><creator>Luijten, Dieuwke</creator><creator>Meijer, Fleur M.M.</creator><creator>Boon, Gudula J.A.M.</creator><creator>Ende-Verhaar, Yvonne M.</creator><creator>Bavalia, Roisin</creator><creator>El Bouazzaoui, Lahassan H.</creator><creator>Delcroix, Marion</creator><creator>Huisman, Menno V.</creator><creator>Mairuhu, Albert T.A.</creator><creator>Middeldorp, Saskia</creator><creator>Pruszcyk, Piotr</creator><creator>Ruigrok, Dieuwertje</creator><creator>Verhamme, Peter</creator><creator>Vonk Noordegraaf, Anton</creator><creator>Vriend, Joris W.J.</creator><creator>Vliegen, Hubert W.</creator><creator>Klok, Frederikus A.</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202209</creationdate><title>Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism</title><author>Luijten, Dieuwke ; Meijer, Fleur M.M. ; Boon, Gudula J.A.M. ; Ende-Verhaar, Yvonne M. ; Bavalia, Roisin ; El Bouazzaoui, Lahassan H. ; Delcroix, Marion ; Huisman, Menno V. ; Mairuhu, Albert T.A. ; Middeldorp, Saskia ; Pruszcyk, Piotr ; Ruigrok, Dieuwertje ; Verhamme, Peter ; Vonk Noordegraaf, Anton ; Vriend, Joris W.J. ; Vliegen, Hubert W. ; Klok, Frederikus A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c432t-dc0ab31fcd6413de3b2de4a1f50abd6634fb5618a81efd975b7eab58447be6133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Algorithm</topic><topic>Diagnosis</topic><topic>Electrocardiography</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - complications</topic><topic>Hypertension, Pulmonary - diagnosis</topic><topic>Pulmonary embolism</topic><topic>Pulmonary Embolism - complications</topic><topic>Pulmonary Embolism - diagnosis</topic><topic>Pulmonary hypertension</topic><topic>Vectorcardiography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Luijten, Dieuwke</creatorcontrib><creatorcontrib>Meijer, Fleur M.M.</creatorcontrib><creatorcontrib>Boon, Gudula J.A.M.</creatorcontrib><creatorcontrib>Ende-Verhaar, Yvonne M.</creatorcontrib><creatorcontrib>Bavalia, Roisin</creatorcontrib><creatorcontrib>El Bouazzaoui, Lahassan H.</creatorcontrib><creatorcontrib>Delcroix, Marion</creatorcontrib><creatorcontrib>Huisman, Menno V.</creatorcontrib><creatorcontrib>Mairuhu, Albert T.A.</creatorcontrib><creatorcontrib>Middeldorp, Saskia</creatorcontrib><creatorcontrib>Pruszcyk, Piotr</creatorcontrib><creatorcontrib>Ruigrok, Dieuwertje</creatorcontrib><creatorcontrib>Verhamme, Peter</creatorcontrib><creatorcontrib>Vonk Noordegraaf, Anton</creatorcontrib><creatorcontrib>Vriend, Joris W.J.</creatorcontrib><creatorcontrib>Vliegen, Hubert W.</creatorcontrib><creatorcontrib>Klok, Frederikus A.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of electrocardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Luijten, Dieuwke</au><au>Meijer, Fleur M.M.</au><au>Boon, Gudula J.A.M.</au><au>Ende-Verhaar, Yvonne M.</au><au>Bavalia, Roisin</au><au>El Bouazzaoui, Lahassan H.</au><au>Delcroix, Marion</au><au>Huisman, Menno V.</au><au>Mairuhu, Albert T.A.</au><au>Middeldorp, Saskia</au><au>Pruszcyk, Piotr</au><au>Ruigrok, Dieuwertje</au><au>Verhamme, Peter</au><au>Vonk Noordegraaf, Anton</au><au>Vriend, Joris W.J.</au><au>Vliegen, Hubert W.</au><au>Klok, Frederikus A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism</atitle><jtitle>Journal of electrocardiology</jtitle><addtitle>J Electrocardiol</addtitle><date>2022-09</date><risdate>2022</risdate><volume>74</volume><spage>94</spage><epage>100</epage><pages>94-100</pages><issn>0022-0736</issn><eissn>1532-8430</eissn><abstract>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).
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.
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.
We could not demonstrate (additional) diagnostic value of VG-RVPO as standalone test or as on top of the InShape II algorithm.
•The VG-RVPO improved over time after acute PE for CTEPH and non-CTEPH patients.•The VG-RVPO as a standalone test does not accurately discriminate CTEPH from non-CTEPH patients.•Additional diagnostic value of VG-RVPO on top of the InShape II algorithm could not be shown.•Our findings should be regarded as hypothesis generating due to low sample size.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36057190</pmid><doi>10.1016/j.jelectrocard.2022.08.007</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Algorithm Diagnosis Electrocardiography Humans Hypertension, Pulmonary - complications Hypertension, Pulmonary - diagnosis Pulmonary embolism Pulmonary Embolism - complications Pulmonary Embolism - diagnosis Pulmonary hypertension Vectorcardiography |
| title | 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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