medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2024-30-28-35medalphabet-3988Research ArticleЭЛЕКТРОКАРДИОЛОГИЯЭЛЕКТРОКАРДИОЛОГИЯЭлектрокардиография при легочной гипертензии: поиск новых диагностических возможностей (обзор литературы)Electrocardiography in pulmonary hypertension: search for new diagnostic possibilities (literature review)https://orcid.org/0000-0002-8040-0770СоболевА. В.SobolevA. V.

Соболев Александр Владимирович, д.т.н., ведущий научный сотрудник Лаборатории ЭКГ 

Sobolev Alexander V., Doctor of Technical Sciences, leading researcher, ECG Laboratory 

https://orcid.org/0000-0001-8725-7084БлиноваЕ. В.BlinovaE. V.

Блинова Елена Валентиновна, к.м.н., научный сотрудник Лаборатории ЭКГ 

Blinova Elena V., Research Officer, ECG Laboratory 

СахноваТ. А.SakhnovaT. A.

Сахнова Тамара Анатольевна, к.м.н., старший научный сотрудник Лаборатории ЭКГ 

Sakhnova Tamara A., Senior Scientist, ECG Laboratory 

tamara-sahnova@mail.ruhttps://orcid.org/0000-0001-7374-3604ДроздовД. В.DrozdovD. V.

Дроздов Дмитрий Владимирович, к.м.н., руководитель Лаборатории ЭКГ 

Drozdov Dmitry V., Head of ECG Laboratory 

ФГБУ «Национальный медицинский исследовательский центр кардиологии имени академика Е.И. Чазова» МЗ РФРоссияFederal State Budgetary Institution «National Medical Research Centre of Cardiology named after academician E.I. Chazov» of the Ministry of Health of the Russian FederationRussian Federation202403122024030"Современная функциональная диагностика" (4)2835Copyright © Соболев А.В., Блинова Е.В., Сахнова Т.А., Дроздов Д.В., 20242024Соболев А.В., Блинова Е.В., Сахнова Т.А., Дроздов Д.В.Sobolev A.V., Blinova E.V., Sakhnova T.A., Drozdov D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/3988

В обзоре освещаются современные клинические рекомендации относительно использования электрокардиографии (ЭКГ) при обследовании больных с легочной гипертензией (ЛГ), приводятся данные о корреляции параметров ЭКГ с показателями гемодинамики при ЛГ, обсуждаются возможности использования ЭКГ при скрининге ЛГ, в том числе, включение показателей ЭКГ в клинические шкалы. Особое внимание уделяется данным о связи изменений ЭКГ с прогнозом больных ЛГ и применению ЭКГ для оценки эффективности лечения ЛГ, в частности, балонной ангиопластики легочной артерии при хронической тромбоэмболической легочной гипертензии. Специальные разделы посвящены таким путям улучшения электрокардиографической диагностики ЛГ, как использование трехмерных векторкардиографических параметров и обработка ЭКГ с привлечением методов глубокого машинного обучения. Описываются «мягкие» функциональные пробы, которые потенциально могут иметь полезную информацию в диагностике ЛГ (проба с водной нагрузкой, пассивный подъем ног, глубокий вдох).

The review covers current clinical guidelines for the use of electrocardiography (ECG) in examining patients with pulmonary hypertension (PH), provides data on the correlation of ECG parameters with hemodynamic parameters in PH, discusses the possibilities of using ECG in PH screening, including the inclusion of ECG parameters in clinical scales. Particular attention is paid to data on the relationship between ECG changes and the prognosis of patients with PH and the use of ECG to assess the effectiveness of PH treatment, in particular, pulmonary artery balloon angioplasty in chronic thromboembolic pulmonary hypertension. Special sections are devoted to such ways of improving electrocardiographic diagnostics of PH as the use of three-dimensional vectorcardiographic parameters and ECG processing using deep machine learning methods. The paper describes «soft» functional tests that can potentially provide useful information in the diagnosis of PH (fluid challenge, passive leg raise, deep inhalation).

легочная гипертензияэлектрокардиограммавекторкардиограммафункциональные пробыглубокое машинное обучениеоценка эффективности леченияпрогнозpulmonary hypertensionelectrocardiogramvectorcardiogramfunctional testsdeep machine learningevaluation of treatment effectivenessprognosisReferencesАвдеев С.Н., Барбараш О.Л., Валиева З.С., Волков А.В., Веселова Т.Н., Галявич А.С., Гончарова Н.С., Горбачевский С.В., Грамович В.В., Данилов Н.М., Клименко А.А., Мартынюк Т.В., Моисеева О.М., Рыжкова Д.В., Симакова М.А., Синицын В.Е., Стукалова О.В., Чазова И.Е., Черногривов И.Е., Шмальц А.А., Царева Н.А. Легочная гипертензия, в том числе хроническая тромбоэмболическая легочная гипертензия. Клинические рекомендации 2024. Российский кардиологический журнал. 2024; 29(11):6161. doi: 10.15829/1560-4071-2024-6161.Avdeev S.N., Barbarash O.L., Valieva Z.S., Volkov A.V., Veselova T.N., Galyavich A.S., Goncharova N.S., Gorbachevsky S.V., Gramovich V.V., Danilov N. M., Klimenko A.A., Martynyuk T.V., Moiseeva O.M., Ryzhkova D.V., Simakova M.A., Sinitsyn V.E., Stukalova O.V., Chazova I.E., Chernogrivov I.E., Shmalts A.A., Tsareva N.A. 2024 Clinical practice guidelines for Pulmonary hypertension, including chronic thromboembolic pulmonary hypertension. Russian Journal of Cardiology. 2024;29(11):6161. doi: 10.15829/1560-4071-2024-6161.Чазова И.Е., Мартынюк Т.В., Шмальц А.А., Грамович В.В., Данилов Н.М., Веселова Т.Н., Коробкова И.З., Сарыбаев А.Ш., Стукалова О.В., Азизов В.А., Барбараш О.Л., Галявич А.С., Горбачевский С.В., Медведева И.В., Матчин Ю.Г., Мукаров М.А., Наконечников С.Н., Филиппов Е.В., Черногривов И.Е. Евразийские рекомендации по диагностике и лечению легочной гипертензии (2023). Евразийский Кардиологический Журнал. 2024; (1): 6–85. https://doi.org/10.38109/2225-1685-2023-1-6-85.Chazova I.E., Martynyuk T.V., Shmalts A.A., Gramovich V.V., Danilov N.M., Veselova T.N., Korobkova I.Z., Sarybaev A.Sh., Stukalova O.V., Barbarash O.L., Azizov V.A., Galyavich A.S., Gorbachevsky S.V., Medvedeva E.A., Matchin Y.G., Mukarov M.A., Nakonechnikov S.N., Filippov E.V., Chernogrivov I.E. Eurasian guidelines for the diagnosis and treatment of pulmonary hypertension (2023). Eurasian heart journal. February 2024;(1):6-85 (in Russ.) https://doi.org/10.38109/2225-1685-2023-1-6-85.Whitman IR, et al. Validity of the surface electrocardiogram criteria for right ventricular hypertrophy: the MESA-RV Study (Multi-Ethnic Study of Atherosclerosis-Right Ventricle). J Am Coll Cardiol. 2014; 63(7): 672–681.Whitman IR, et al. Validity of the surface electrocardiogram criteria for right ventricular hypertrophy: the MESA-RV Study (Multi-Ethnic Study of Atherosclerosis-Right Ventricle). J Am Coll Cardiol. 2014; 63(7): 672–681.Mirtajaddini M, Naderi N, Chenaghlou M, Taghavi S, Amin A. The prediction of right atrial pressure using electrocardiogram: a novel approach. ESC Heart Fail. 2021; 8(6):5040-5044. doi: 10.1002/ehf2.13570.Mirtajaddini M, Naderi N, Chenaghlou M, Taghavi S, Amin A. The prediction of right atrial pressure using electrocardiogram: a novel approach. ESC Heart Fail. 2021; 8(6):5040-5044. doi: 10.1002/ehf2.13570.Luo J, Sun J, Xu L, Chen J, Chen Y, Chen W, Qiu H, Luo X, Chen S, Li J. Analysis of relationship between P wave dispersion and diagnosis of pulmonary arterial hypertension and risk stratification. J Electrocardiol. 2023; 81:94–100. doi: 10.1016/j.jelectrocard.2023.08.002.Luo J, Sun J, Xu L, Chen J, Chen Y, Chen W, Qiu H, Luo X, Chen S, Li J. Analysis of relationship between P wave dispersion and diagnosis of pulmonary arterial hypertension and risk stratification. J Electrocardiol. 2023; 81:94–100. doi: 10.1016/j.jelectrocard.2023.08.002.Michalski TA, Pszczola J, Lisowska A, Knapp M, Sobkowicz B, Kaminski K, Ptaszynska-Kopczynska K. ECG in the clinical and prognostic evaluation of patients with pulmonary arterial hypertension: an underestimated value. Ther Adv Respir Dis. 2022; 16:17534666221087846. doi: 10.1177/17534666221087846.Michalski TA, Pszczola J, Lisowska A, Knapp M, Sobkowicz B, Kaminski K, Ptaszynska-Kopczynska K. ECG in the clinical and prognostic evaluation of patients with pulmonary arterial hypertension: an underestimated value. Ther Adv Respir Dis. 2022; 16:17534666221087846. doi: 10.1177/17534666221087846.Sławek-Szmyt S, Araszkiewicz A, Jankiewicz S, Smukowska-Gorynia A, Grygier M, Janus M, Lesiak M, Mularek-Kubzdela T. Association of Electrocardiographic Signs of Right Ventricular Hypertrophy and Clot Localization in Chronic Thromboembolic Pulmonary Hypertension. J Clin Med. 2022; 11(3):625. doi: 10.3390/jcm11030625.Sławek-Szmyt S, Araszkiewicz A, Jankiewicz S, Smukowska-Gorynia A, Grygier M, Janus M, Lesiak M, Mularek-Kubzdela T. Association of Electrocardiographic Signs of Right Ventricular Hypertrophy and Clot Localization in Chronic Thromboembolic Pulmonary Hypertension. J Clin Med. 2022; 11(3):625. doi: 10.3390/jcm11030625.Tokgöz HC, Öcal BE, Erkuş YC, Tanyeri S, Kültürsay B, Tosun A, Keskin B, Hakgör A, Sırma D, Buluş Ç, Karagöz A, Tanboğa İH, Külahçıoğlu Ş, Bayram Z, Sekban A, Özdemir N, Kaymaz C. Remembering the Occam’s Razor: Could Simple Electrocardiographic Findings Provide Relevant Predictions for Current Hemodynamic Criteria of Pulmonary Hypertension? Anatol J Cardiol. 2023; 27(11):664–672. doi: 10.14744/AnatolJCardiol.2023.3181.Tokgöz HC, Öcal BE, Erkuş YC, Tanyeri S, Kültürsay B, Tosun A, Keskin B, Hakgör A, Sırma D, Buluş Ç, Karagöz A, Tanboğa İH, Külahçıoğlu Ş, Bayram Z, Sekban A, Özdemir N, Kaymaz C. Remembering the Occam’s Razor: Could Simple Electrocardiographic Findings Provide Relevant Predictions for Current Hemodynamic Criteria of Pulmonary Hypertension? Anatol J Cardiol. 2023; 27(11):664–672. doi: 10.14744/AnatolJCardiol.2023.3181.Waligóra M, Smorąg M, Bukała N, Zygmunt M, Kachnic N, Lis E, Zaczyńska K, Wilczek Ł, Wziątek B, Kopeć G. ECG patterns to predict pulmonary arterial hypertension in patients with severe tricuspid regurgitation. J Electrocardiol. 2024; 82:52–58. doi: 10.1016/j.jelectrocard.2023.11.009.Waligóra M, Smorąg M, Bukała N, Zygmunt M, Kachnic N, Lis E, Zaczyńska K, Wilczek Ł, Wziątek B, Kopeć G. ECG patterns to predict pulmonary arterial hypertension in patients with severe tricuspid regurgitation. J Electrocardiol. 2024; 82:52–58. doi: 10.1016/j.jelectrocard.2023.11.009.Elitok A, Emet S, Karaayvaz EB, Erdogan O, Aydogan M, Engin B, Cevik E, Orta H, Okumus G, Bilge AK. The relationship between T-wave peak-to-end interval and hemodynamic parameters in patients with pulmonary arterial hypertension. Ann Noninvasive Electrocardiol. 2020; 25(5): e12764. doi: 10.1111/anec.12764.Elitok A, Emet S, Karaayvaz EB, Erdogan O, Aydogan M, Engin B, Cevik E, Orta H, Okumus G, Bilge AK. The relationship between T-wave peak-to-end interval and hemodynamic parameters in patients with pulmonary arterial hypertension. Ann Noninvasive Electrocardiol. 2020; 25(5): e12764. doi: 10.1111/anec.12764.Сахнова Т.А., Блинова Е.В., Рябыкина Г.В., Белевская А.А., Юрасова Е.С., Родненков О.В., Мартынюк Т.В., Саидова М.А. Тип комплекса QRS как показатель тяжести поражения сердца у больных легочной гипертензией. Кардиологический вестник. – 2020. Т. 15, № 1. с. 37–45. doi:10.36396/MS.2020.82.98.006.Sakhnova T.A., Blinova E.V., Ryabykina G.V., Belevskaya A.A., Yurasova E.S., Rodnenkov O.V., Martynyuk T.V., Saidova M.A. The type of QRS complex as an indicator of the severity of heart damage in patients with pulmonary hypertension. Cardiological Bulletin. – 2020. Vol. 15, No. 1, pp. 37–45. doi:10.36396/MS.2020.82.98.006.Wang F, Wang L, Yan C, Chang X, Wang H, Zhu K, Xu Y, Xu D. Algorithms of Electrocardiographic Changes for Quantitative and Localization Analysis of Thrombus Burden in Patients with Acute Pulmonary Thromboembolism. Rev Cardiovasc Med. 2023; 24(10):281. doi: 10.31083/j.rcm2410281.Wang F, Wang L, Yan C, Chang X, Wang H, Zhu K, Xu Y, Xu D. Algorithms of Electrocardiographic Changes for Quantitative and Localization Analysis of Thrombus Burden in Patients with Acute Pulmonary Thromboembolism. Rev Cardiovasc Med. 2023; 24(10):281. doi: 10.31083/j.rcm2410281.Jansen SMA, Huis In ’t Veld AE, Jacobs W, Grotjohan HP, Waskowsky M, van der Maten J, van der Weerdt A, Hoekstra R, Overbeek MJ, Mollema SA, Tolen PHCG, Hassan El Bouazzaoui LH, Vriend JWJ, Roorda JMM, de Nooijer R, van der Lee I, Voogel BAJ, Peels K, Macken T, Aerts JM, Vonk Noordegraaf A, Handoko ML, de Man FS, Bogaard HJ. Noninvasive Prediction of Elevated Wedge Pressure in Pulmonary Hypertension Patients Without Clear Signs of Left-Sided Heart Disease: External Validation of the OPTICS Risk Score. J Am Heart Assoc. 2020; 9(15): e015992. doi: 10.1161/JAHA.119.015992.Jansen SMA, Huis In ’t Veld AE, Jacobs W, Grotjohan HP, Waskowsky M, van der Maten J, van der Weerdt A, Hoekstra R, Overbeek MJ, Mollema SA, Tolen PHCG, Hassan El Bouazzaoui LH, Vriend JWJ, Roorda JMM, de Nooijer R, van der Lee I, Voogel BAJ, Peels K, Macken T, Aerts JM, Vonk Noordegraaf A, Handoko ML, de Man FS, Bogaard HJ. Noninvasive Prediction of Elevated Wedge Pressure in Pulmonary Hypertension Patients Without Clear Signs of Left-Sided Heart Disease: External Validation of the OPTICS Risk Score. J Am Heart Assoc. 2020; 9(15): e015992. doi: 10.1161/JAHA.119.015992.Coghlan JG, Denton CP, Grünig E, Bonderman D, Distler O, Khanna D, Müller-Ladner U, Pope JE, Vonk MC, Doelberg M, Chadha-Boreham H, Heinzl H, Rosenberg DM, McLaughlin VV, Seibold JR; DETECT study group. Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study. Ann Rheum Dis. 2014; 73(7):1340-9. doi: 10.1136/annrheumdis-2013-203301.Coghlan JG, Denton CP, Grünig E, Bonderman D, Distler O, Khanna D, Müller-Ladner U, Pope JE, Vonk MC, Doelberg M, Chadha-Boreham H, Heinzl H, Rosenberg DM, McLaughlin VV, Seibold JR; DETECT study group. Evidence-based detection of pulmonary arterial hypertension in systemic sclerosis: the DETECT study. Ann Rheum Dis. 2014; 73(7):1340-9. doi: 10.1136/annrheumdis-2013-203301.Dzikowska-Diduch O, Kurnicka K, Lichodziejewska B, Dudzik-Niewiadomska I, Machowski M, Roik M, Wiśniewska M, Siwiec J, Staniszewska IM, Pruszczyk P. Electrocardiogram, Echocardiogram and NT-proBNP in Screening for Thromboembolism Pulmonary Hypertension in Patients after Pulmonary Embolism. J Clin Med. 2022; 11(24):7369. doi: 10.3390/jcm11247369.Dzikowska-Diduch O, Kurnicka K, Lichodziejewska B, Dudzik-Niewiadomska I, Machowski M, Roik M, Wiśniewska M, Siwiec J, Staniszewska IM, Pruszczyk P. Electrocardiogram, Echocardiogram and NT-proBNP in Screening for Thromboembolism Pulmonary Hypertension in Patients after Pulmonary Embolism. J Clin Med. 2022; 11(24):7369. doi: 10.3390/jcm11247369.Nilsson LT, Andersson T, Carlberg B, Johansson LÅ, Söderberg S. Electrocardiographic abnormalities and NT-proBNP levels at long-term follow-up of patients with dyspnea after pulmonary embolism. Scand Cardiovasc J. 2024; 58(1):2373090. doi: 10.1080/14017431.2024.2373090.Nilsson LT, Andersson T, Carlberg B, Johansson LÅ, Söderberg S. Electrocardiographic abnormalities and NT-proBNP levels at long-term follow-up of patients with dyspnea after pulmonary embolism. Scand Cardiovasc J. 2024; 58(1):2373090. doi: 10.1080/14017431.2024.2373090.Dai J, Liu T, Zhang H, Sun X, Tang Y, Qian W, Zhang Y, Ye H, Shan L, Li L, Du M, Li D, Zhu Y, Ma K, Liu L, Wang Q, Zhou L. Fragmented QRS complex could predict all-cause mortality in patients with connective tissue disease-associated pulmonary arterial hypertension. Rheumatology (Oxford). 2024: keae084. doi: 10.1093/rheumatology/keae084.Dai J, Liu T, Zhang H, Sun X, Tang Y, Qian W, Zhang Y, Ye H, Shan L, Li L, Du M, Li D, Zhu Y, Ma K, Liu L, Wang Q, Zhou L. Fragmented QRS complex could predict all-cause mortality in patients with connective tissue disease-associated pulmonary arterial hypertension. Rheumatology (Oxford). 2024: keae084. doi: 10.1093/rheumatology/keae084.Hendriks PM, Kauling RM, Geenen LW, Eindhoven JA, Roos-Hesselink JW, Boomars KA, van den Bosch AE. Role of the electrocardiogram in the risk stratification of pulmonary hypertension. Heart. 2023; 109(3):208-215. doi: 10.1136/heartjnl-2022-321475.Hendriks PM, Kauling RM, Geenen LW, Eindhoven JA, Roos-Hesselink JW, Boomars KA, van den Bosch AE. Role of the electrocardiogram in the risk stratification of pulmonary hypertension. Heart. 2023; 109(3):208-215. doi: 10.1136/heartjnl-2022-321475.Waligóra M, Gliniak M, Bylica J, Pasieka P, Łączak P, Podolec P, Kopeć G. Extended Precordial T Wave Inversions Are Associated with Right Ventricular Enlargement and Poor Prognosis in Pulmonary Hypertension. J Clin Med. 2021; 10(10):2147. doi: 10.3390/jcm10102147.Waligóra M, Gliniak M, Bylica J, Pasieka P, Łączak P, Podolec P, Kopeć G. Extended Precordial T Wave Inversions Are Associated with Right Ventricular Enlargement and Poor Prognosis in Pulmonary Hypertension. J Clin Med. 2021; 10(10):2147. doi: 10.3390/jcm10102147.Lui JK, Sangani RA, Chen CA, Bujor AM, Trojanowski MA, Gopal DM, LaValley MP, Soylemez Wiener R, Klings ES. Prognostic Value of Cardiac Axis Deviation in Systemic Sclerosis-Related Pulmonary Hypertension. Arthritis Care Res (Hoboken). 2022; 74(7):1219–1226. doi: 10.1002/acr.24724.Lui JK, Sangani RA, Chen CA, Bujor AM, Trojanowski MA, Gopal DM, LaValley MP, Soylemez Wiener R, Klings ES. Prognostic Value of Cardiac Axis Deviation in Systemic Sclerosis-Related Pulmonary Hypertension. Arthritis Care Res (Hoboken). 2022; 74(7):1219–1226. doi: 10.1002/acr.24724.Minhas J, Moutchia J, Al-Naamani N, Mazurek JA, Holmes JH, Appleby D, Smith KA, Fritz JS, Pugliese SC, Palevsky HI, Kawut SM. Electrocardiographic Abnormalities and Their Association with Outcomes in Randomized Clinical Trials of Pulmonary Arterial Hypertension. Ann Am Thorac Soc. 2024; 21(6):858–865. doi: 10.1513/AnnalsATS.202307-609OC.Minhas J, Moutchia J, Al-Naamani N, Mazurek JA, Holmes JH, Appleby D, Smith KA, Fritz JS, Pugliese SC, Palevsky HI, Kawut SM. Electrocardiographic Abnormalities and Their Association with Outcomes in Randomized Clinical Trials of Pulmonary Arterial Hypertension. Ann Am Thorac Soc. 2024; 21(6):858–865. doi: 10.1513/AnnalsATS.202307-609OC.Карабашева М.Б., Данилов Н.М., Сагайдак О.В., Матчин Ю.Г., Чазова И.Е. Динамика ЭКГ-показателей у больных хронической тромбоэмболической легочной гипертензией после транслюминальной баллонной ангиопластики легочных артерий. Системные гипертензии. 2019;16(2):28–31. doi: 10.26442/2075082X.2019.2.190180.Karabasheva M.B., Danilov N.M., Sagaidak O.V., Matchin Iu.G., Chazova I.E. Dynamics of ECG indicators in patients with chronic thromboembolic pulmonary hypertension after transluminal pulmonary balloon angioplasty. Systemic Hypertension. 2019; 16 (2): 28–31.(In Russ.) DOI: 10.26442/2075082X.2019.2.190180.Piłka M, Darocha S, Banaszkiewicz M, Wieteska-Miłek M, Mańczak M, Mańczak R, Kędzierski P, Florczyk M, Dobosiewicz A, Torbicki A, Kurzyna M. Assessment of electrocardiographic markers of acute and long-term hemodynamic improvement in patients with pulmonary hypertension. Ann Noninvasive Electrocardiol. 2020; 25(5): e12758. doi: 10.1111/anec.12758.Piłka M, Darocha S, Banaszkiewicz M, Wieteska-Miłek M, Mańczak M, Mańczak R, Kędzierski P, Florczyk M, Dobosiewicz A, Torbicki A, Kurzyna M. Assessment of electrocardiographic markers of acute and long-term hemodynamic improvement in patients with pulmonary hypertension. Ann Noninvasive Electrocardiol. 2020; 25(5): e12758. doi: 10.1111/anec.12758.Kariki O, Karyofyllis P, Mililis P, Saplaouras A, Dragasis S, Chatziantoniou A, Alexiou D, Patsiotis IG, Letsas KP, Efremidis M. Electrocardiographic changes after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: Data from the Hellenic Registry. J Electrocardiol. 2023;81:26-31. doi: 10.1016/j.jelectrocard.2023.07.006.Kariki O, Karyofyllis P, Mililis P, Saplaouras A, Dragasis S, Chatziantoniou A, Alexiou D, Patsiotis IG, Letsas KP, Efremidis M. Electrocardiographic changes after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: Data from the Hellenic Registry. J Electrocardiol. 2023;81:26-31. doi: 10.1016/j.jelectrocard.2023.07.006.Kol A, Kepez A, Akaslan D, Kanar B, Atas H, Mutlu B. Effects of balloon pulmonary angioplasty procedure on electrocardiographic parameters in patients with chronic thromboembolic pulmonary hypertension. J Electrocardiol. 2023; 77:72–77. doi: 10.1016/j.jelectrocard.2023.01.013.Kol A, Kepez A, Akaslan D, Kanar B, Atas H, Mutlu B. Effects of balloon pulmonary angioplasty procedure on electrocardiographic parameters in patients with chronic thromboembolic pulmonary hypertension. J Electrocardiol. 2023; 77:72–77. doi: 10.1016/j.jelectrocard.2023.01.013.Guo T, Zeng XM, Huang HQ, Wu XF, Guo WL, Chen HM, Zhong QN, Yang X, Ye HL, Hong C. ECG changes following balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: a retrospective study. J Cardiothorac Surg. 2024;19(1):484. doi: 10.1186/s13019-024-02960-z.Guo T, Zeng XM, Huang HQ, Wu XF, Guo WL, Chen HM, Zhong QN, Yang X, Ye HL, Hong C. ECG changes following balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: a retrospective study. J Cardiothorac Surg. 2024;19(1):484. doi: 10.1186/s13019-024-02960-z.Ley L, Wiedenroth CB, Ghofrani HA, Hoeltgen R, Bandorski D. Analysis of Electrocardiographic Criteria of Right Ventricular Hypertrophy in Patients with Chronic Thromboembolic Pulmonary Hypertension before and after Balloon Pulmonary Angioplasty. J Clin Med. 2023; 12(13):4196. doi: 10.3390/jcm12134196.Ley L, Wiedenroth CB, Ghofrani HA, Hoeltgen R, Bandorski D. Analysis of Electrocardiographic Criteria of Right Ventricular Hypertrophy in Patients with Chronic Thromboembolic Pulmonary Hypertension before and after Balloon Pulmonary Angioplasty. J Clin Med. 2023; 12(13):4196. doi: 10.3390/jcm12134196.Piłka M, Mańczak M, Darocha S, Banaszkiewicz M, Mańczak R, Florczyk M, Kędzierski P, Pietrasik A, Balsam P, Kurzyna P, Wasilewski M, Wolański R, Torbicki A, Kurzyna M. Assessment of Clinical Usefulness of Resting Electrocardiogram (PHECG Score) in Monitoring the Efficacy of Balloon Pulmonary Angioplasty (BPA) in Patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH). J Clin Med. 2021; 10(19):4548. doi: 10.3390/jcm10194548.Piłka M, Mańczak M, Darocha S, Banaszkiewicz M, Mańczak R, Florczyk M, Kędzierski P, Pietrasik A, Balsam P, Kurzyna P, Wasilewski M, Wolański R, Torbicki A, Kurzyna M. Assessment of Clinical Usefulness of Resting Electrocardiogram (PHECG Score) in Monitoring the Efficacy of Balloon Pulmonary Angioplasty (BPA) in Patients with Chronic Thromboembolic Pulmonary Hypertension (CTEPH). J Clin Med. 2021; 10(19):4548. doi: 10.3390/jcm10194548.Piłka M, Darocha S, Florczyk M, Mańczak R, Banaszkiewicz M, Kędzierski P, Zieliński D, Wróbel K, Torbicki 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(24):7621. doi: 10.3390/jcm12247621.Piłka M, Darocha S, Florczyk M, Mańczak R, Banaszkiewicz M, Kędzierski P, Zieliński D, Wróbel K, Torbicki 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(24):7621. doi: 10.3390/jcm12247621.Şahan E, Aydemir S. Evaluation of thrombolytic treatment effect on frontal plane QRS-T angle in patients with acute pulmonary embolism: A novel marker of successful thrombolysis. Herz. 2021; 46(Suppl 2):187–190. doi: 10.1007/s00059-020-04978-0.Şahan E, Aydemir S. Evaluation of thrombolytic treatment effect on frontal plane QRS-T angle in patients with acute pulmonary embolism: A novel marker of successful thrombolysis. Herz. 2021; 46(Suppl 2):187–190. doi: 10.1007/s00059-020-04978-0.Wade RC, Mkorombindo T, Ling SX, Helgeson ES, MacDonald DM, Pew K, Voelker H, Bittner V, Kunisaki KM, Lammi MR, Dransfield MT. Association between P-pulmonale and respiratory morbidity in COPD: a secondary analysis of the BLOCKCOPD trial. BMC Pulm Med. 2023; 23(1):434. doi: 10.1186/s12890-023-02748-2.Wade RC, Mkorombindo T, Ling SX, Helgeson ES, MacDonald DM, Pew K, Voelker H, Bittner V, Kunisaki KM, Lammi MR, Dransfield MT. Association between P-pulmonale and respiratory morbidity in COPD: a secondary analysis of the BLOCKCOPD trial. BMC Pulm Med. 2023; 23(1):434. doi: 10.1186/s12890-023-02748-2.Pan D, Liu R, Ren S, Li C, Chang Q.Prediction of Pulmonary Arterial Hypertension in Chronic Obstructive Lung Disease from Three-Dimensional Vectorcardiographic Parameters. Ann Noninvasive Electrocardiol. 2016; 21(3): 280-6. doi: 10.1111/anec.12305.Pan D, Liu R, Ren S, Li C, Chang Q.Prediction of Pulmonary Arterial Hypertension in Chronic Obstructive Lung Disease from Three-Dimensional Vectorcardiographic Parameters. Ann Noninvasive Electrocardiol. 2016; 21(3): 280-6. doi: 10.1111/anec.12305.Haeck ML, Kapel GF, Scherptong RW, Swenne CA, Maan AC, Bax JJ, Schalij MJ, Vliegen HW. Detection of elevated pulmonary pressures by the ECG-derived ventricular gradient: A comparison of conversion matrices in patients with suspected pulmonary hypertension. J Electrocardiol. 2017; 50(1): 115-122. doi: 10.1016/j.jelectrocard.2016.09.002.Haeck ML, Kapel GF, Scherptong RW, Swenne CA, Maan AC, Bax JJ, Schalij MJ, Vliegen HW. Detection of elevated pulmonary pressures by the ECG-derived ventricular gradient: A comparison of conversion matrices in patients with suspected pulmonary hypertension. J Electrocardiol. 2017; 50(1): 115-122. doi: 10.1016/j.jelectrocard.2016.09.002.Couperus LE, Vliegen HW, Henkens IR, Maan AC, Treskes RW, de Vries JK, Schouffoer AA, Swenne CA, Schalij MJ, Scherptong RW. Electrocardiographic detection of pulmonary hypertension in patients with systemic sclerosis using the ventricular gradient. J Electrocardiol. 2016; 49(1):60-8. doi: 10.1016/j.jelectrocard.2015.09.003.Couperus LE, Vliegen HW, Henkens IR, Maan AC, Treskes RW, de Vries JK, Schouffoer AA, Swenne CA, Schalij MJ, Scherptong RW. Electrocardiographic detection of pulmonary hypertension in patients with systemic sclerosis using the ventricular gradient. J Electrocardiol. 2016; 49(1):60-8. doi: 10.1016/j.jelectrocard.2015.09.003.Meijer FMM, Kies P, Jongbloed MRM, van Wijngaarden SE, Swenne CA, Man S, Schalij MJ, de Vries-Bouwstra JK, Vliegen HW. ECG derived ventricular gradient exceeds echocardiography in the early detection of pulmonary hypertension in scleroderma patients. Int J Cardiol. 2018; 273:203-206. doi: 10.1016/j.ijcard.2018.07.122.Meijer FMM, Kies P, Jongbloed MRM, van Wijngaarden SE, Swenne CA, Man S, Schalij MJ, de Vries-Bouwstra JK, Vliegen HW. ECG derived ventricular gradient exceeds echocardiography in the early detection of pulmonary hypertension in scleroderma patients. Int J Cardiol. 2018; 273:203-206. doi: 10.1016/j.ijcard.2018.07.122.Kamphuis VP, Haeck ML, Wagner GS, Maan AC, Maynard C, Delgado V, Vliegen HW, Swenne CA. Electrocardiographic detection of right ventricular pressure overload in patients with suspected pulmonary hypertension. J Electrocardiol. 2014; 47(2):175-82. doi: 10.1016/j.jelectrocard.2013.10.010.Kamphuis VP, Haeck ML, Wagner GS, Maan AC, Maynard C, Delgado V, Vliegen HW, Swenne CA. Electrocardiographic detection of right ventricular pressure overload in patients with suspected pulmonary hypertension. J Electrocardiol. 2014; 47(2):175-82. doi: 10.1016/j.jelectrocard.2013.10.010.Jaroszyński A, Schlegel TT, Zaborowski T, Zapolski T, Załuska W, Janion-Sadowska A, Kozieł D, Głuszek S, Dąbrowski W. The value of ventricular gradient for predicting pulmonary hypertension and mortality in hemodialysis patients. Sci Rep. 2022; 12(1):456. doi: 10.1038/s41598-021-04186-8.Jaroszyński A, Schlegel TT, Zaborowski T, Zapolski T, Załuska W, Janion-Sadowska A, Kozieł D, Głuszek S, Dąbrowski W. The value of ventricular gradient for predicting pulmonary hypertension and mortality in hemodialysis patients. Sci Rep. 2022; 12(1):456. doi: 10.1038/s41598-021-04186-8.El-Bokl A, Jimenez E, Hiremath G, Cortez D. Is derived vectorcardiography a potential screening tool for pulmonary hypertension? J Electrocardiol. 2022; 70:79-83. doi: 10.1016/j.jelectrocard.2021.12.004.El-Bokl A, Jimenez E, Hiremath G, Cortez D. Is derived vectorcardiography a potential screening tool for pulmonary hypertension? J Electrocardiol. 2022; 70:79-83. doi: 10.1016/j.jelectrocard.2021.12.004.Meijer FMM, Hendriks SV, Huisman MV, van der Hulle T, Swenne CA, Kies P, Jongbloed MRM, Egorova AD, Vliegen HW, Klok FA. Lack of diagnostic utility of the ECG-derived ventricular gradient in patients with suspected acute pulmonary embolism. J Electrocardiol. 2020; 61:141–146. doi: 10.1016/j.jelectrocard.2020.06.006.Meijer FMM, Hendriks SV, Huisman MV, van der Hulle T, Swenne CA, Kies P, Jongbloed MRM, Egorova AD, Vliegen HW, Klok FA. Lack of diagnostic utility of the ECG-derived ventricular gradient in patients with suspected acute pulmonary embolism. J Electrocardiol. 2020; 61:141–146. doi: 10.1016/j.jelectrocard.2020.06.006.Luijten D, Meijer FMM, Boon GJAM, Ende-Verhaar YM, Bavalia R, El Bouazzaoui LH, Delcroix M, Huisman MV, Mairuhu ATA, Middeldorp S, Pruszcyk P, Ruigrok D, Verhamme P, Vonk Noordegraaf A, Vriend JWJ, Vliegen HW, Klok FA. Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism. J Electrocardiol. 2022; 74:94-100. doi: 10.1016/j.jelectrocard.2022.08.007.Luijten D, Meijer FMM, Boon GJAM, Ende-Verhaar YM, Bavalia R, El Bouazzaoui LH, Delcroix M, Huisman MV, Mairuhu ATA, Middeldorp S, Pruszcyk P, Ruigrok D, Verhamme P, Vonk Noordegraaf A, Vriend JWJ, Vliegen HW, Klok FA. Diagnostic efficacy of ECG-derived ventricular gradient for the detection of chronic thromboembolic pulmonary hypertension in patients with acute pulmonary embolism. J Electrocardiol. 2022; 74:94-100. doi: 10.1016/j.jelectrocard.2022.08.007.DuBrock HM, Wagner TE, Carlson K, Carpenter CL, Awasthi S, Attia ZI, Frantz RP, Friedman PA, Kapa S, Annis J, Brittain EL, Hemnes AR, Asirvatham SJ, Babu M, Prasad A, Yoo U, Barve R, Selej M, Agron P, Kogan E, Quinn D, Dunnmon P, Khan N, Soundararajan V. An electrocardiogram-based AI algorithm for early detection of pulmonary hypertension. Eur Respir J. 2024; 64(1):2400192. doi: 10.1183/13993003.00192-2024.DuBrock HM, Wagner TE, Carlson K, Carpenter CL, Awasthi S, Attia ZI, Frantz RP, Friedman PA, Kapa S, Annis J, Brittain EL, Hemnes AR, Asirvatham SJ, Babu M, Prasad A, Yoo U, Barve R, Selej M, Agron P, Kogan E, Quinn D, Dunnmon P, Khan N, Soundararajan V. An electrocardiogram-based AI algorithm for early detection of pulmonary hypertension. Eur Respir J. 2024; 64(1):2400192. doi: 10.1183/13993003.00192-2024.Tison GH, Zhang J, Delling FN, Deo RC. Automated and Interpretable Patient ECG Profiles for Disease Detection, Tracking, and Discovery. Circ Cardiovasc Qual Outcomes. 2019; 12(9): e005289. doi: 10.1161/CIRCOUTCOMES.118.005289.Tison GH, Zhang J, Delling FN, Deo RC. Automated and Interpretable Patient ECG Profiles for Disease Detection, Tracking, and Discovery. Circ Cardiovasc Qual Outcomes. 2019; 12(9): e005289. doi: 10.1161/CIRCOUTCOMES.118.005289.Aras MA, Abreau S, Mills H, Radhakrishnan L, Klein L, Mantri N, Rubin B, Barrios J, Chehoud C, Kogan E, Gitton X, Nnewihe A, Quinn D, Bridges C, Butte AJ, Olgin JE, Tison GH. Electrocardiogram Detection of Pulmonary Hypertension Using Deep Learning. J Card Fail. 2023; 29(7):1017–1028. doi: 10.1016/j.cardfail.2022.12.016.Aras MA, Abreau S, Mills H, Radhakrishnan L, Klein L, Mantri N, Rubin B, Barrios J, Chehoud C, Kogan E, Gitton X, Nnewihe A, Quinn D, Bridges C, Butte AJ, Olgin JE, Tison GH. Electrocardiogram Detection of Pulmonary Hypertension Using Deep Learning. J Card Fail. 2023; 29(7):1017–1028. doi: 10.1016/j.cardfail.2022.12.016.Kwon JM, Kim KH, Medina-Inojosa J, Jeon KH, Park J, Oh BH. Artificial intelligence for early prediction of pulmonary hypertension using electrocardiography. J Heart Lung Transplant. 2020; 39(8):805-814. doi: 10.1016/j.healun.2020.04.009.Kwon JM, Kim KH, Medina-Inojosa J, Jeon KH, Park J, Oh BH. Artificial intelligence for early prediction of pulmonary hypertension using electrocardiography. J Heart Lung Transplant. 2020; 39(8):805-814. doi: 10.1016/j.healun.2020.04.009.Liu CM, Shih ESC, Chen JY, Huang CH, Wu IC, Chen PF, Higa S, Yagi N, Hu YF, Hwang MJ, Chen SA. Artificial Intelligence-Enabled Electrocardiogram Improves the Diagnosis and Prediction of Mortality in Patients with Pulmonary Hypertension. JACC Asia. 2022; 2(3):258-270. doi: 10.1016/j.jacasi.2022.02.008.Liu CM, Shih ESC, Chen JY, Huang CH, Wu IC, Chen PF, Higa S, Yagi N, Hu YF, Hwang MJ, Chen SA. Artificial Intelligence-Enabled Electrocardiogram Improves the Diagnosis and Prediction of Mortality in Patients with Pulmonary Hypertension. JACC Asia. 2022; 2(3):258-270. doi: 10.1016/j.jacasi.2022.02.008.Liu PY, Hsing SC, Tsai DJ, Lin C, Lin CS, Wang CH, Fang WH. A Deep-Learning-Enabled Electrocardiogram and Chest X-Ray for Detecting Pulmonary Arterial Hypertension. J Imaging Inform Med. 2024. doi: 10.1007/s10278-024-01225-4.Liu PY, Hsing SC, Tsai DJ, Lin C, Lin CS, Wang CH, Fang WH. A Deep-Learning-Enabled Electrocardiogram and Chest X-Ray for Detecting Pulmonary Arterial Hypertension. J Imaging Inform Med. 2024. doi: 10.1007/s10278-024-01225-4.Moghaddam N, Swiston JR, Weatherald J, Mielniczuk L, Kapasi A, Hambly N, Langleben D, Brunner NW. Impact of saline loading at cardiac catheterization on the classification and management of patients evaluated for pulmonary hypertension. Int J Cardiol. 2020; 306:181-186. doi: 10.1016/j.ijcard.2019.11.104.Moghaddam N, Swiston JR, Weatherald J, Mielniczuk L, Kapasi A, Hambly N, Langleben D, Brunner NW. Impact of saline loading at cardiac catheterization on the classification and management of patients evaluated for pulmonary hypertension. Int J Cardiol. 2020; 306:181-186. doi: 10.1016/j.ijcard.2019.11.104.Qaiser KN, Almoushref A, Mehta AK, Alkhayyat M, Lane JE, Tonelli AR. Fluid loading during the hemodynamic evaluation of pulmonary hypertension: a cross-sectional study. Cardiovasc Diagn Ther. 2023; 13(5):833-842. doi: 10.21037/cdt-23-59.Qaiser KN, Almoushref A, Mehta AK, Alkhayyat M, Lane JE, Tonelli AR. Fluid loading during the hemodynamic evaluation of pulmonary hypertension: a cross-sectional study. Cardiovasc Diagn Ther. 2023; 13(5):833-842. doi: 10.21037/cdt-23-59.Kremer N, Rako Z, Douschan P, Gall H, Ghofrani HA, Grimminger F, Guth S, Naeije R, Rieth A, Schulz R, Seeger W, Tedford RJ, Vadász I, Vanderpool R, Wiedenroth CB, Richter MJ, Tello K. Unmasking right ventricular-arterial uncoupling during fluid challenge in pulmonary hypertension. J Heart Lung Transplant. 2022; 41(3):345-355. doi: 10.1016/j.healun.2021.11.019.Kremer N, Rako Z, Douschan P, Gall H, Ghofrani HA, Grimminger F, Guth S, Naeije R, Rieth A, Schulz R, Seeger W, Tedford RJ, Vadász I, Vanderpool R, Wiedenroth CB, Richter MJ, Tello K. Unmasking right ventricular-arterial uncoupling during fluid challenge in pulmonary hypertension. J Heart Lung Transplant. 2022; 41(3):345-355. doi: 10.1016/j.healun.2021.11.019.D’Alto M, Motoji Y, Romeo E, Argiento P, Di Marco GM, Mattera Iacono A, D’Andrea A, Rea G, Golino P, Naeije R. Fluid challenge predicts clinical worsening in pulmonary arterial hypertension. Int J Cardiol. 2018; 261:167-171. doi: 10.1016/j.ijcard.2018.03.020.D’Alto M, Motoji Y, Romeo E, Argiento P, Di Marco GM, Mattera Iacono A, D’Andrea A, Rea G, Golino P, Naeije R. Fluid challenge predicts clinical worsening in pulmonary arterial hypertension. Int J Cardiol. 2018; 261:167-171. doi: 10.1016/j.ijcard.2018.03.020.Arunachalam A, Chaisson NF, Tonelli AR. Methods to improve the yield of right heart catheterization in pulmonary hypertension. Respiratory Medicine: X. 2020; 2:100015. doi: 10.1016/j.yrmex.2020.100015.Arunachalam A, Chaisson NF, Tonelli AR. Methods to improve the yield of right heart catheterization in pulmonary hypertension. Respiratory Medicine: X. 2020; 2:100015. doi: 10.1016/j.yrmex.2020.100015.Montané B, Tonelli AR, Arunachalam A, Bhattacharyya A, Li M, Wang X, Chaisson NF. Hemodynamic Responses to Provocative Maneuvers during Right Heart Catheterization. Ann Am Thorac Soc. 2022; 19(12):1977-1985. doi: 10.1513/AnnalsATS.202201-077OC.Montané B, Tonelli AR, Arunachalam A, Bhattacharyya A, Li M, Wang X, Chaisson NF. Hemodynamic Responses to Provocative Maneuvers during Right Heart Catheterization. Ann Am Thorac Soc. 2022; 19(12):1977-1985. doi: 10.1513/AnnalsATS.202201-077OC.Баркан ВС, Дроздов ДВ, Резвецов ГД. Электрокардиограмма на вдохе: физиологические механизмы и диагностические возможности пробы. Медицинский алфавит. 2023; (22):36–42. Doi:10.33667/2078-5631-2023-22-36-42.Barkan V.S., Drozdov D.V., Rezvetsov G.G. Deep inspiration electrocardiogram test: physiologic mechanisms and diagnostic capabilities. Medical alphabet. 2023;(22):36–42. DOI 10.33667/2078-5631-2023-22-36-42.Сахнова Т.А., Блинова Е.В., Мартынюк Т.В., Белевская А.А., Саидова М.А., Дроздов Д.В. Связь изменений электрической оси сердца на вдохе со структурно-функциональным состоянием сердца по данным эхокардиографии у больных прекапиллярной легочной гипертензией Системные гипертензии. 2024;21(2):5–20. Doi: 10.38109/2075-082X-2024-2-5-20.Sakhnova T.A., Blinova E.V., Martynyuk T.V., Belevskaya A.A., Saidova M.A., Drozdov D.V. Relationship between changes in the electrical axis of the heart during inspiration and the structural and functional state of the heart according to echocardiography in patients with precapillary pulmonary hypertension. Systemic Hypertension. 2024;21(2):25-35. (in Russ.). https://doi.org/10.38109/2075-082X-2024-2-25-32.Bacharova L, Chevalier P, Gorenek B, Jons C, Li YG, Locati ET, Maanja M, Pérez-Riera AR, Platonov PG, Ribeiro ALP, Schocken D, Soliman EZ, Svehlikova J, Tereshchenko LG, Ugander M, Varma N, Zaklyazminskaya E, Ikeda T. ISE/ISHNE expert consensus statement on the ECG diagnosis of left ventricular hypertrophy: The change of the paradigm. Ann Noninvasive Electrocardiol. 2024; 29(1):e13097. doi: 10.1111/anec.13097.Bacharova L, Chevalier P, Gorenek B, Jons C, Li YG, Locati ET, Maanja M, Pérez-Riera AR, Platonov PG, Ribeiro ALP, Schocken D, Soliman EZ, Svehlikova J, Tereshchenko LG, Ugander M, Varma N, Zaklyazminskaya E, Ikeda T. ISE/ISHNE expert consensus statement on the ECG diagnosis of left ventricular hypertrophy: The change of the paradigm. Ann Noninvasive Electrocardiol. 2024; 29(1):e13097. doi: 10.1111/anec.13097.

The authors declare that there are no conflicts of interest present.