Association of Electrocardiographic Signs of Right Ventricular Hypertrophy and Clot Localization in Chronic Thromboembolic Pulmonary Hypertension

Sylwia Sławek-Szmyt; Aleksander Araszkiewicz; Stanisław Jankiewicz; Anna Smukowska-Gorynia; Marek Grygier; Magdalena Janus; Maciej Lesiak; Tatiana Mularek-Kubzdela

doi:10.3390/jcm11030625

Association of Electrocardiographic Signs of Right Ventricular Hypertrophy and Clot Localization in Chronic Thromboembolic Pulmonary Hypertension

J Clin Med. 2022 Jan 26;11(3):625. doi: 10.3390/jcm11030625.

Authors

Sylwia Sławek-Szmyt¹, Aleksander Araszkiewicz¹, Stanisław Jankiewicz¹, Anna Smukowska-Gorynia¹, Marek Grygier¹, Magdalena Janus¹, Maciej Lesiak¹, Tatiana Mularek-Kubzdela¹

Affiliation

¹ 1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland.

Abstract

The role of electrocardiography (ECG) in chronic thromboembolic pulmonary hypertension (CTEPH) diagnosis and prognosticating has not been yet established. We aimed to assess the relationships of the recommended ECG criteria of right ventricular hypertrophy (RVH) with clot localization in CTEPH patients. ECG patterns of RVH according to the American College of Cardiology Foundation were assessed in patients with newly diagnosed CTEPH. We enrolled 58 (45.3%) patients with proximal and 70 (54.7%) with distal CTEPH. Receiver-operating characteristics curves analysis indicated that the following ECG abnormalities predicted proximal CTEPH localization: R_V1 > 6 mm-AUC 0.75 (CI: 0.66-0.84, p < 0.00001); S_V6 > 3 mm-AUC 0.70 (CI: 0.60-0.79, p < 0.00001); S_I > R_I wave-AUC 0.67 (CI: 0.58-0.77, p = 0.0004); R_V1:S_V1 > 1.0-AUC 0.66 (CI: 0.56-0.76, p = 0.0009); R_V1 peak > 0.035 s (QRS < 120 ms)-AUC 0.66 (CI: 0.56-0.75, p = 0.0016); R_V1:S_V1 > R_V3(V4):S_V3(V4)-AUC-0.65 (CI: 0.54-0.75, p = 0.0081); R_aVR > 4 mm-AUC 0.62 (CI: 0.52-0.71, p = 0.002) and P_II > 2.5 mm-AUC 0.62 (CI: 0.52-0.72, p = 0.00162). Pulmonary vascular resistance significantly correlated with amplitudes of R_V1 (r = 0.34, p = 0.008), S_V6 (r = 0.53, p = 0.000027) and P_II (r = 0.44, p = 0.00007). In patients with CTEPH, only 8 out of 23 ECG RVH criteria were useful for differentiating between proximal and distal CTEPH localization and we found that R_V1 and S_V6 may contribute as potential discriminators.

Keywords: chronic thromboembolic pulmonary hypertension; clot localization; diagnosis; electrocardiogram; right ventricular hypertrophy.