Key result
An abnormal baseline ECG was associated with significantly worse transplant-free survival compared to a normal ECG (64.0% vs 86.0%; p=0.037) in patients with PAH or CTEPH.
Why the study?
Prognosis in pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension remains dismal, and better risk prediction is needed.
Do baseline ECG characteristics predict transplant-free survival in treatment-naïve patients with PAH or CTEPH?
Cohort (n=140)
No
Do baseline ECG characteristics predict transplant-free survival in treatment-naïve patients with PAH or CTEPH?
Absolute Event Rate: 64% vs 86%
p-value: p=0.037
Baseline ECG abnormalities, particularly prolonged QRS duration and increased S-wave amplitude in V5, provide significant prognostic value for predicting mortality or lung transplantation in patients with PAH and CTEPH.
Abnormal baseline ECGs may aid risk stratification in PAH/CTEPH; leaves open whether ECG findings should guide therapy or require prospective validation.
INTRODUCTION: The prognosis of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) remains dismal. Better risk prediction is needed. This study investigated the prognostic value of ECG characteristics. METHODS: In this single-centre prospective study, consecutive treatment-naïve patients with PAH or CTEPH were included at time of diagnosis. From the 12-lead ECG, obtained at baseline, the following parameters were collected: heart rate (HR), rhythm, QRS axis, conduction times, P-top amplitudes in II, R-top and S-wave amplitudes in V1 and V5 and repolarisation disorders. Associations between the ECG and transplant-free survival was assessed by Kaplan-Meier curves and Cox-proportional hazard regressions. RESULTS: In total, 140 patients were included (median age: 60.7 years, 63.6% female). The ECG was abnormal in 86.2%: sinus rhythm was not present in 9.3%, right QRS axis was observed in 47.8%, mean QRS duration was 101±17 ms. Only 42.5% of the patients had normal repolarisation, 34.5% had right ventricular strain and 14.4% non-specific repolarisation disorders. Over a median follow-up time of 3.49 (IQR: 1.37-6.42) years, 45 patients (32.5%) died or underwent lung transplantation. Transplant-free survival was worse in patients presenting with an abnormal ECG (64.0% vs 86.0%; p=0.037). The following ECG characteristics were associated with all-cause mortality or lung transplantation: heart rate (HR 1.02, 95% CI: 1.00 to 1.05), QRS duration >120 ms (HR 2.61, 95% CI: 1.01 to 6.71) and S-wave amplitude in V5 (HR 1.10, 95% CI: 1.04 to 1.17). CONCLUSION: Only 13.8% of patients with PAH and CTEPH presented with a normal ECG, which is associated with favourable outcome. The ECG provides additional prognostic value to current clinical parameters and should be considered in risk prediction.
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Hendriks et al. (2022) conducted a cohort in Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) (n=140). Abnormal ECG vs. Normal ECG was evaluated on Transplant-free survival (p=0.037). An abnormal baseline ECG was associated with significantly worse transplant-free survival compared to a normal ECG (64.0% vs 86.0%; p=0.037) in patients with PAH or CTEPH.
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