A simple electrocardiographic model for an improved detection of chronic thromboembolic pulmonary hypertension after pulmonary embolism.

Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is considered a late sequelae of a preceding pulmonary embolism (PE). There is reasonable suspicion that the majority of CTEPH patients are currently not detected. The aim of the present study was to evaluate the potential utility of a simple electrocardiographic (ECG) model for an improved detection of CTEPH after PE.

Material And Methods: The present study was conducted as a bicentric, retrospective cross-sectional study in two German high volume referral centres for pulmonary hypertension (PH) between February 2011 and September 2023. A total of 100 patients with CTEPH and 100 patients with excluded PH were included. An ECG model for detecting CTEPH consisting of a screening test and confirmatory test was developed and subsequently tested on the present CTEPH cohort and a hypothetical cohort of PE survivors from Germany.

Results: Applying this ECG model to the present CTEPH cohort, 79 % of CTEPH patients were correctly identified (sensitivity: 79 %) and only 8 % of non-PH patients were incorrectly identified as PH patients (specificity: 92 %). When theoretically applying this model in CTEPH screening of a hypothetical cohort of persistently symptomatic PE survivors, a total 70 % of CTEPH patients could potentially be detected (sensitivity: 70 %) and right heart catheterisations (RHC) without pathological findings would only be performed on 2.5 % of non-CTEPH patients (specificity: 97.5 %) without the application of echocardiography. Compared to the current estimated CTEPH detection rate this would be about a threefold increase (from 24 % to 70 %).

Conclusion: Electrocardiographic CTEPH screening could potentially increase the CTEPH detection rate significantly, without the application of echocardiography and with performance of only very few RHCs without pathological findings, if all persistently symptomatic PE survivors were given a simple ECG as standard follow-up. However, the present approach remains largely hypothetical for now and must be validated externally.