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

1Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands, 2Department of Cardiology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands, 3Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands, 4Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Noord-Holland, Netherlands, 5Department of Pulmonology, Haga Teaching Hospital, Den Haag, Zuid-Holland, Netherlands, 6Department of Pneumology, KU Leuven University Hospitals Leuven, Leuven, Vlaams-Brabant, Belgium, 7Department of Internal Medicine, Haga Teaching Hospital, Den Haag, Zuid-Holland, Netherlands, 8Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands, Leiden, Zuid-Holland, Netherlands, 9Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Noord-Holland, Netherlands, 10Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warszawa, Mazowieckie, Poland, 11Department of Pulmonology, Amsterdam UMC, VU University Medical Centre, Amsterdam, Noord-Holland, Netherlands, 12Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium, Leuven, Vlaams-Brabant, Belgium, 13Department of Cardiology, Haga Teaching Hospital, Den Haag, Zuid-Holland, Netherlands, 14Leiden University Medical Center, Leiden, the Netherlands, Leiden, Zuid-Holland, Netherlands

Abstract Number: PB0974

Meeting: ISTH 2022 Congress

Theme: Venous Thromboembolism » VTE Diagnosis

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.

Table

VG-RVPO measurements in the study patients

Table

Results of the incremental diagnostic value of the VG-RVPO as new rule-out criteria in 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/