PB0974 - Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Dieuwke Luijten, MD

MD, PhD candidate
Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

FM

Fleur MM Meijer

MD, PhD
Department of Cardiology, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
GB

Gudula JAM Boon

MD, PhD candidate
Department of Medicine – Thrombosis and Hemostasis, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
YE

Yvonne M. Ende-Verhaar

MD, PhD
Department of Internal Medicine, Haaglanden Medisch Centrum
the Hague, Zuid-Holland, Netherlands
RB

Roisin Bavalia

MD, PhD
Amsterdam UMC location University of Amsterdam, Department of Vascular Medicine, the Netherlands
Amsterdam, Noord-Holland, Netherlands
LE

Lahassan H El Bouazzaoui

MD
Department of Pulmonology, Haga Teaching Hospital
Den Haag, Zuid-Holland, Netherlands
MD

Marion Delcroix

MD, PhD
Department of Respiratory Diseases, University Hospital of Leuven
Leuven, Vlaams-Brabant, Belgium
AM

Albert T.A. Mairuhu

MD, PhD
Department of Vascular Medicine, Haga Hospital
the Hague, Zuid-Holland, Netherlands
MH

Menno V. Huisman

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands
SM

Saskia Middeldorp

MD, PhD, prof
Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam
Amsterdam, Noord-Holland, Netherlands
PP

Piotr Pruszcyk

MD, PhD
Department of Internal Medicine and Cardiology, Medical University of Warsaw
Warsaw, Mazowieckie, Poland
DR

Dieuwertje Ruigrok

MD, PhD
Department of Pulmonology, Amsterdam UMC, VU University Medical Centre
Amsterdam, Noord-Holland, Netherlands
PV

Peter Verhamme, MD, PhD

MD, PhD
University Hospitals Leuven, Belgium
Leuven, Vlaams-Brabant, Belgium
AV

Anton Vonk Noordegraaf

MD, PhD
Department of Pulmonology, Amsterdam UMC, VU University Medical Centre
Amsterdam, Noord-Holland, Netherlands
JV

Joris WJ Vriend

MD, PhD
Department of Cardiology, Haga Teaching Hospital
Den Haag, Zuid-Holland, Netherlands
HV

Hubert W Vliegen

MD, PhD
Department of Cardiology, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
Frederikus A. Klok, MD, PhD

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands

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.