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CHEST 2021: EKG Parameters In Predicting Survivals In Pulmonary Arterial Hypertension

Kraisangka, J., Scott, J.,  Kanwar, M., Liu, Z., Lin, S., Everett, A., Perer, A., Movahedi, F., Antaki, J., Benza, R. “EKG Parameters In Predicting Survivals In Pulmonary Arterial Hypertension.” Chest, vol. 160, no. 4, Oct. 2021, pp. A2325–26.

PURPOSE: EKG parameters are ones of the predictors for prognosis of the patients with pulmonary arterial hypertension (PAH).

METHODS: We analyzed the imaging and EKG variables obtained at baseline in 4 PAH clinical trials: SERAPHIN, BREATHE-1, CHEST-2, and PATENT-2. The outcome of the analysis was mortality at the time to event of each individual trial. We selected only the significant EKG variables (p-value<0.05) to be aggregated across the clinical trials using Stouffer’s method, weighed by their ‘N’ in the clinical trials.

RESULTS: Collective data from 1,579 patients were available at baseline with 10 EKG variables. Out of the 10, only 4 variables were still significant (p-value<0.05) after the aggregation of p-values: 1) Non-sinus rhythms: HR=6.11 [1.36; 27.33], aggregated p-value=0.0180, N=213; 2) Mean ventricular rate (beat/min): HR=1.04 [1.02; 1.07], aggregated p-value=0.0011, N=393; 3) QRS interval (ms): HR=0.99 [0.95; 1.03], aggregated p-value=0.0242, N=948; and 4) Atrial or ventricular extrasystole: HR=0.35 [0.04; 3.33], aggregated p-value=0.0041, N=231. The most predictive variable to mortality were non-sinus rhythm followed by the mean ventricular rate, while the presence of atrial or ventricular extrasystole is protective.

CONCLUSIONS: To our knowledge, this is the largest aggregated attempt to analyze EKG parameters in predicting survivals. This analysis will be used to select features for the derivation of machine-learned PAH patient risk stratification models

CLINICAL IMPLICATIONS: Our long-term goal is to generate a comprehensive personalized risk assessment tool from the data-driven variable selections to aid clinical decisions.

https://doi.org/10.1016/j.chest.2021.07.2019.