Effects of balloon pulmonary angioplasty procedure on electrocardiographic parameters in patients with chronic thromboembolic pulmonary hypertension

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease of obstructive pulmonary artery remodeling following pulmonary thromboembolism. The cumulative incidence has been reported to range from 0.1 to 9.1% within the first 2 years after a symptomatic pulmonary embolism event [1]. Pulmonary endarterectomy (PEA) is the treatment of choice for patients with accessible pulmonary artery lesions [2]. Most patients' symptoms and hemodynamics improve to near normal levels after surgery [[3], [4], [5], [6]].

Balloon pulmonary angioplasty (BPA) is the treatment of choice when pulmonary endarterectomy (PEA) cannot be performed in patients with CTEPH. Previous studies have reported significant improvement in mortality and morbidity after BPA [[7], [8], [9]]. A recent European Society of Cardiology (ESC) guideline for the diagnosis and treatment of pulmonary hypertension [10] has recommended BPA for patients who are technically inoperable or have residual pulmonary hypertension after PEA and distal obstructions amenable to BPA with class 1 indication.

Clinical follow-up of patients after BPA is performed by assessing the functional status (classified functionally according to the WHO/NYHA functional class and assessed with the 6-min walk test) and NT-proBNP levels and by performing transthoracic echocardiography and right heart catheterization in our center. Right heart catheterization (RHC) is performed routinely during follow-up to evaluate the hemodynamic response after BPA.

Twelve‑lead electrocardiography (12‑lead ECG) has been suggested to play a role in the risk stratification of patients with pulmonary hypertension [11]. Electrocardiographic alterations after the BPA procedure were evaluated in several previous studies [[12], [13], [14]]. Alterations in various ECG markers have been suggested to be related to a more favorable hemodynamic and/or functional improvement.

The aim of the present study was to investigate alterations in ECG parameters after the BPA procedure in patients with CTEPH. We also aimed to evaluate the association between possible electrocardiographic alterations and improvements in hemodynamics, symptomatic functional status and right ventricular function after the procedure.

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