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<p>Persistent pulmonary hypertension (PH) and chronic thromboembolic pulmonary hypertension(CTEPH) are important complications after acute pulmonary embolism(PE), yet early risk stratification remains limited. We evaluated whether admission electrocardiographic markers of atrial cardiomyopathy are associated with 3-month persistent PH and confirmed CTEPH. This single-center retrospective cohort included 1,579 consecutive adults with computed tomography pulmonary angiography-confirmed acute PE between August 2018 and August 2025. All underwent admission electrocardiography and structured 3-month echocardiographic reassessment.The primary outcome was persistent PH, defined as intermediate/high echocardiographic PH probability at 3&#xa0;months; the secondary outcome was confirmed CTEPH.The sinus rhythm subset was defined a priori for evaluating P-wave–based markers, including P-wave indices, P-terminal force in lead V1 (PTFV1), and interatrial block. Persistent PH occurred in 292 patients (18.5%), and confirmed CTEPH in 44 (2.8%). Because CTEPH work-up was mainly triggered by intermediate/high echocardiographic PH probability, confirmed CTEPH was ascertained within the persistent PH group. In the sinus rhythm subset, persistent PH was associated with longer P-wave duration, greater dispersion, higher PTFV1, and more frequent interatrial block (all p &lt; 0.001). After adjustment, PTFV1 (OR 1.21 per 10&#xa0;mm·ms, 95% CI 1.14–1.29; p &lt; 0.001) and interatrial block (OR 1.78, 95% CI 1.28–2.49; p = 0.001) remained independently associated with persistent PH and confirmed CTEPH. Among acute PE survivors in sinus rhythm, P-wave–based ECG markers of atrial cardiomyopathy, particularly PTFV1 and interatrial block, were independently associated with persistent PH and confirmed CTEPH. These exploratory risk-enrichment markers are not applicable to non-sinus rhythms and require external validation.</p> Graphical abstract <p>Admission Atrial ECG Markers Predict Post-PE Pulmonary Hypertension. Admission Electrocardiographic Markers of Atrial Cardiomyopathy and Post-Pulmonary Embolism Outcomes. The graphical abstract summarizes the study design, admission electrocardiographic assessment, principal findings, and potential clinical implications. Among 1,579 patients with acute pulmonary embolism who underwent structured 3-month echocardiographic reassessment, persistent pulmonary hypertension was identified in 292 patients (18.5%), and confirmed chronic thromboembolic pulmonary hypertension was diagnosed in 44 patients (2.8%). In the prespecified sinus rhythm subset (n = 1,290), P-terminal force in lead V1 and interatrial block were independently associated with persistent pulmonary hypertension and confirmed chronic thromboembolic pulmonary hypertension. If externally validated, these readily available ECG markers may serve as non-invasive risk-enrichment tools for guiding post-pulmonary embolism follow-up. Abbreviations: CI, confidence interval; CTEPH, chronic thromboembolic pulmonary hypertension; ECG, electrocardiography; IAB, interatrial block; OR, odds ratio; PE, pulmonary embolism; PH, pulmonary hypertension; PTFV1, P-terminal force in lead V1.</p> <p></p>

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Admission electrocardiographic markers of atrial cardiomyopathy predict persistent pulmonary hypertension and chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年7月31日

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  • Sefa Erdi Ömür,
  • Çağrı Zorlu,
  • Metin Karayakalı,
  • Kayıhan Karaman,
  • Gülşen Genç Tapar,
  • Ataç Çelik

摘要

Persistent pulmonary hypertension (PH) and chronic thromboembolic pulmonary hypertension(CTEPH) are important complications after acute pulmonary embolism(PE), yet early risk stratification remains limited. We evaluated whether admission electrocardiographic markers of atrial cardiomyopathy are associated with 3-month persistent PH and confirmed CTEPH. This single-center retrospective cohort included 1,579 consecutive adults with computed tomography pulmonary angiography-confirmed acute PE between August 2018 and August 2025. All underwent admission electrocardiography and structured 3-month echocardiographic reassessment.The primary outcome was persistent PH, defined as intermediate/high echocardiographic PH probability at 3 months; the secondary outcome was confirmed CTEPH.The sinus rhythm subset was defined a priori for evaluating P-wave–based markers, including P-wave indices, P-terminal force in lead V1 (PTFV1), and interatrial block. Persistent PH occurred in 292 patients (18.5%), and confirmed CTEPH in 44 (2.8%). Because CTEPH work-up was mainly triggered by intermediate/high echocardiographic PH probability, confirmed CTEPH was ascertained within the persistent PH group. In the sinus rhythm subset, persistent PH was associated with longer P-wave duration, greater dispersion, higher PTFV1, and more frequent interatrial block (all p < 0.001). After adjustment, PTFV1 (OR 1.21 per 10 mm·ms, 95% CI 1.14–1.29; p < 0.001) and interatrial block (OR 1.78, 95% CI 1.28–2.49; p = 0.001) remained independently associated with persistent PH and confirmed CTEPH. Among acute PE survivors in sinus rhythm, P-wave–based ECG markers of atrial cardiomyopathy, particularly PTFV1 and interatrial block, were independently associated with persistent PH and confirmed CTEPH. These exploratory risk-enrichment markers are not applicable to non-sinus rhythms and require external validation.

Graphical abstract

Admission Atrial ECG Markers Predict Post-PE Pulmonary Hypertension. Admission Electrocardiographic Markers of Atrial Cardiomyopathy and Post-Pulmonary Embolism Outcomes. The graphical abstract summarizes the study design, admission electrocardiographic assessment, principal findings, and potential clinical implications. Among 1,579 patients with acute pulmonary embolism who underwent structured 3-month echocardiographic reassessment, persistent pulmonary hypertension was identified in 292 patients (18.5%), and confirmed chronic thromboembolic pulmonary hypertension was diagnosed in 44 patients (2.8%). In the prespecified sinus rhythm subset (n = 1,290), P-terminal force in lead V1 and interatrial block were independently associated with persistent pulmonary hypertension and confirmed chronic thromboembolic pulmonary hypertension. If externally validated, these readily available ECG markers may serve as non-invasive risk-enrichment tools for guiding post-pulmonary embolism follow-up. Abbreviations: CI, confidence interval; CTEPH, chronic thromboembolic pulmonary hypertension; ECG, electrocardiography; IAB, interatrial block; OR, odds ratio; PE, pulmonary embolism; PH, pulmonary hypertension; PTFV1, P-terminal force in lead V1.