Prognostic Value of ECG Among Patients with Acute Pulmonary Embolism and Normal Blood Pressure

  • S. V
  • G. P
  • R. V
 et al. 
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Abstract

Objective: To investigate the prognostic value of electrocardiography (ECG) alone or in combination with echocardiography in patients with acute pulmonary embolism and normal blood pressure. Methods: Consecutive adult patients presenting to the emergency department at Azienda Ospedaliero-Universitaria Careggi with the first episode of pulmonary embolism were included. Patients with systolic blood pressure less than 100 mm Hg were excluded. ECG and echocardiography were performed within 1 hour from diagnosis and evaluated in a blinded fashion. Right ventricular strain was diagnosed in the presence of one or more of the following ECG findings: complete or incomplete right ventricular branch block, S1Q3T3, and negative T wave in V1-V4. The main outcome measurement was clinical deterioration or death during in-hospital stay. The association of variables with the main outcome was evaluated by multivariate Cox survival analysis. Results: A total of 386 patients with proved pulmonary embolism were included in the study; 201 patients (52%) had right ventricular dysfunction according to echocardiography, and 130 patients (34%) showed right ventricular strain. Twenty-three patients (6%) had clinical deterioration or died. At multivariate survival analysis, right ventricular strain was associated with adverse outcome (hazard ratio 2.58; 95% confidence interval, 1.05-6.36) independently of echocardiographic findings. Patients with both right ventricular strain and right ventricular dysfunction (26%) showed an 8-fold elevated risk of adverse outcome (hazard ratio 8.47; 95% confidence interval, 2.43-29.47). Conclusion: Right ventricular strain pattern on ECG is associated with adverse short-term outcome and adds incremental prognostic value to echocardiographic evidence of right ventricular dysfunction in patients with acute pulmonary embolism and normal blood pressure. © 2009 Elsevier Inc. All rights reserved.

Author-supplied keywords

  • 80 and over
  • Adolescent
  • Adult
  • Aged
  • Blood Pressure
  • Echocardiography
  • Electrocardiography
  • Female
  • Fibrinolytic Agents
  • Heparin
  • Humans
  • Male
  • Middle Aged
  • Myocardium
  • Prognosis
  • Pulmonary Embolism
  • Right
  • T wave
  • Troponin I
  • Ventricular Dysfunction
  • Young Adult
  • administration & dosage
  • analysis
  • article
  • blood pressure
  • chemistry
  • deterioration
  • diagnosis
  • diagnostic imaging
  • drug therapy
  • echocardiography
  • electrocardiography
  • heart right ventricle failure
  • human
  • lung embolism
  • methods
  • physiology
  • physiopathology
  • priority journal
  • prognosis

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Authors

  • Vanni S.

  • Polidori Pepe G.

  • Vergara R.

  • Polidori Pepe G.

  • Nazerian P.

  • Moroni F.

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