Background: Application of the chronic thromboembolic pulmonary hypertension (CTEPH)-rule out criteria (manual electrocardiogram [ECG] reading and N-terminal pro-brain natriuretic peptide [NTproBNP] blood test) can rule out CTEPH in patients with pulmonary embolism (PE) and persistent dyspnea without echocardiography (InShape II algorithm). Increased pulmonary pressure in CTEPH may also be identified using automated ECG-derived ventricular gradient optimized for right ventricular pressure overload (VG-RVPO).
Aims: 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.
Methods: A predefined analysis of the Inshape II study was performed, which included all patients in whom a baseline ECG and a follow-up ECG 3-6 months after PE diagnosis were available.
Results: 60 PE patients were included of which 5 (8.3%) were ultimately diagnosed with CTEPH. The mean baseline VG-RVPO 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 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 group 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 detection of CTEPH was moderate to poor (ROC AUC 0.611, 0.514 and 0.539, respectively). Up to 76% of the needed echocardiograms could have been avoided with VG-RVPO as new rule-out criteria in the Inshape II algorithm, however at cost of missing up to 80% of the CTEPH diagnosis. Only one scenario decreased the need for echocardiograms with 9.5% and detected all CTEPH cases
Conclusion(s): We could not demonstrate additional diagnostic value of VG-RVPO as standalone test or as on top of the InShape II algorithm.
To cite this abstract in AMA style:Luijten D, Meijer F, Boon G, Ende-Verhaar Y, Bavalia R, El Bouazzaoui L, Delcroix M, Mairuhu A, Huisman M, Middeldorp S, Pruszcyk P, Ruigrok D, Verhamme P, Vonk Noordegraafonk Noordegraaf A, Vriend J, Vliegen H, Klok F. Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism [abstract]. https://abstracts.isth.org/abstract/diagnostic-efficacy-of-ecg-derived-ventricular-gradient-for-the-detection-of-chronic-thromboembolic-pulmonary-hypertension-in-patients-with-acute-pulmonary-embolism/. Accessed October 1, 2023.
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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/diagnostic-efficacy-of-ecg-derived-ventricular-gradient-for-the-detection-of-chronic-thromboembolic-pulmonary-hypertension-in-patients-with-acute-pulmonary-embolism/