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Dong R, Liang Y, Ni M, Wang D, Zhang J, Dun Z. Electrocardiogram Parameters Associated With the Diagnosis of Pulmonary Hypertension in High-Altitude Tibetan Populations: A Retrospective Single-Centre Study. Heart Lung Circ 2024; 33:240-250. [PMID: 38177015 DOI: 10.1016/j.hlc.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/23/2023] [Accepted: 10/28/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Electrocardiogram (ECG) is a commonly used diagnostic method for pulmonary hypertension (PH) in Tibetan areas, but its sensitivity and specificity are not good enough. This study aimed to investigate the ECG parameters associated with the diagnosis of PH in Tibetan areas. METHODS Ninety-four PH patients of Tibetan ethnicity who were treated at the hospital between March 2019 and October 2020, and 52 Tibetan individuals as controls, were included. The ECG parameters were compared between groups. Multivariate logistic analysis was performed to identify the ECG parameters that can be used for the diagnosis of PH. The univariate significances of ECG parameters were included in the multivariate analyses, whereas those exhibiting opposite trends between different PH subtypes were excluded. RESULTS Two ECG parameters were significant in multivariate analysis. The final model included S wave amplitude in lead V3 (OR 5.81; 95% CI 2.79-12.11; p<0.001) and a negative T wave in leads V1-V3 (OR 0.05; 95% CI 0.01-0.41; p=0.005). The ROC curve analysis on the final model yielded an AUC of 0.830 (95% CI 0.766-0.894; p<0.001), indicating good diagnostic performance. A nomogram for diagnosis of PH was also established using S wave amplitude in lead V3 and a negative T wave in leads V1-V3. CONCLUSION The ECG parameters S wave amplitude in lead V3 and a negative T wave in leads V1-V3 were independent factors associated with the diagnosis of PH in high-altitude Tibetan populations.
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Affiliation(s)
- Ruimin Dong
- Department of Cardiology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Yu'en Liang
- Electrocardiogram Room, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ma Ni
- Electrocardiogram Room, Chaya County People's Hospital, Changdu, Tibet, China
| | - Dengdi Wang
- Electrocardiogram Room, Chaya County People's Hospital, Changdu, Tibet, China
| | - Juan Zhang
- Department of Internal Medicine, Chaya County People's Hospital, Changdu, Tibet, China
| | - Zhu Dun
- Department of Surgery, Chaya County People's Hospital, Changdu, Tibet, China.
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Piłka M, Darocha S, Florczyk M, Mańczak R, Banaszkiewicz M, Kędzierski P, Zieliński D, Wróbel K, Torbicki A, Kurzyna M. The Utility of a Resting Electrocardiogram (ECG-PH Index) in Evaluating the Efficacy of Pulmonary Endarterectomy in Chronic Thromboembolic Pulmonary Hypertension. J Clin Med 2023; 12:7621. [PMID: 38137690 PMCID: PMC10743524 DOI: 10.3390/jcm12247621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/27/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND The ECG-PH index (PH-ECG score) has been proposed as a valuable ECG-derived method of evaluating the effectiveness of balloon pulmonary angioplasty (BPA) in chronic thromboembolic pulmonary hypertension (CTEPH). Pulmonary endarterectomy (PEA) is the main form of therapy for CTEPH with a proximal clot location. The objective of this study was to assess the clinical utility of a resting electrocardiogram (ECG-PH index) in assessing the effectiveness of PEA in CTEPH patients. METHODS The retrospective analysis included 73 patients who underwent PEA. Their ECG-PH index values were calculated using four ECG parameters: R-wave amplitude V1 + S-wave amplitude V5/V6 > 10.5 mm, QRS-wave axis > 110 degrees, R-wave amplitude V1 > S-wave amplitude V1, and SIQIII pattern. PH-ECG scores were assessed after a median time of 13 months (IQR: 8-31 months) had passed since the PEA procedures. RESULTS The current analysis documented that ECG-PH index = 0 is a good reflection of mPAP < 25mmHg (sensitivity 76.1%; specificity 66.7%; positive predictive value 79.5%; negative predictive value 62.1%) or mPAP ≤ 20 mmHg (sensitivity 69.6%; specificity 70.6%; positive predictive value 88.6%; negative predictive value 41.4%) after PEA. The values of the area under the ROC curve for ECG-PH index were 0.772 (95% CI: 0.676-0.867) and 0.743 (95% CI: 0.637-0.849) for the mPAP < 25 mmHg and mPAP ≤ 20 mmHg patient groups, respectively. CONCLUSION The ECG-PH index may be useful for monitoring the haemodynamic effect of PEA in CTEPH patients.
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Affiliation(s)
- Michał Piłka
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Szymon Darocha
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Michał Florczyk
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Rafał Mańczak
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Marta Banaszkiewicz
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Piotr Kędzierski
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Dariusz Zieliński
- Cardiac Surgery Department, Medicover Hospital, 02-972 Warsaw, Poland; (D.Z.); (K.W.)
- Faculty of Medicine, Lazarski University, 02-662 Warsaw, Poland
| | - Krzysztof Wróbel
- Cardiac Surgery Department, Medicover Hospital, 02-972 Warsaw, Poland; (D.Z.); (K.W.)
- Faculty of Medicine, Lazarski University, 02-662 Warsaw, Poland
| | - Adam Torbicki
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
| | - Marcin Kurzyna
- Chair and Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Center of Postgraduate Medical Education, European Health Center, ERN-LUNG Member, 05-400 Otwock, Poland; (S.D.); (M.F.); (R.M.); (M.B.); (P.K.); (A.T.); (M.K.)
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Su XF, Fan N, Yang XM, Song JM, Peng QH, Liu X. A Novel Electrocardiography Model for the Diagnosis of Acute Pulmonary Embolism. Front Cardiovasc Med 2022; 9:825561. [PMID: 35479265 PMCID: PMC9035687 DOI: 10.3389/fcvm.2022.825561] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Acute pulmonary embolism (acPE) is a severe disease that is often misdiagnosed as it is difficult to detect quickly and accurately. In this study, a novel electrocardiogram (ECG) model was used to estimate the probability of acPE rapidly via analysis of ECG characteristics. A total of 327 patients with acPE who were diagnosed at the Sichuan Provincial People's Hospital (SPPH) between 2018 and 2021 were retrospectively studied. A total of 331 patients were randomly selected as the control group, which included patients hospitalized during the same time period. The control group included patients who presented with characteristic symptoms of acPE, but this diagnosis was ruled out following further diagnostic testing. This study compared the diagnostic value of the ECG model with those of another ECG scoring model (Daniel-ECG score) and the most common prediction models (Wells score and Geneva score). This study established an ECG-predictive model using analysis of the ECG abnormalities in patients with acPE. The final ECG model included certain novel ECG signs that had not been incorporated in the previous ECG score of the patients, and thus, compared to the previous ECG score, exhibited a more favorable area under the receiver operating characteristic curve (AUC) value (0.8741). The model developed in this study was named the SPPH-ECG model. Furthermore, this study compared the SPPH-ECG model with Daniel-ECG score, Wells score, and Geneva score, and the SPPH-ECG model was demonstrated to exhibit a superior AUC value (0.8741), sensitivity (79.08%), negative predictive value (79.52%), and test accuracy (79.42%), while the Geneva score presented superior specificity (100%) and positive predictive value (100%) compared with the SPPH-ECG model. In conclusion, the SPPH-ECG model may play a role in ruling out acPE in patients during diagnostic testing and diagnose acPE rapidly and accurately in combination with the Geneva scoring system.
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Affiliation(s)
- Xiao-Feng Su
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Na Fan
- Department of Echocardiography and Non-Invasive Cardiology Laboratory, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Xue-Mei Yang
- Sichuan Provincial People's Hospital, Chengdu, China
| | - Jun-Mei Song
- Sichuan Provincial People's Hospital, Chengdu, China
| | | | - Xin Liu
- Sichuan Provincial People's Hospital, Chengdu, China
- *Correspondence: Xin Liu
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