Characteristics of synthesized right-sided chest electrocardiograms in patients with acute pulmonary embolism

Kusayama, Takashi; Furusho, Hiroshi; Kinoshita, Masaki; Kaneko, Shuichi; Usuda, Kazuo; Takamura, Masayuki

doi:10.1016/j.jjcc.2018.12.010

Cited by 4 publications

(4 citation statements)

References 33 publications

(58 reference statements)

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“…It has been postulated that biochemical abnormalities and hypoxia of the myocardium and His-Purkinje system cause slowing conduction in the right ventricle. Studies have shown that ST-segment and T-wave changes are associated with acute pulmonary embolism [ 3 , 5 ]. Our patient’s T-wave inversion in V1 to V5 and lead II, III, and AVF concur with previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple literature reviews have described changes in ECG in acute pulmonary embolism; however, it has low specificity. ECG changes, such as sinus tachycardia, S1Q3T3, and right strain pattern, have been described, and they show a correlation with acute pulmonary embolism despite low sensitivity [1][2][3][4][5]. Biphasic T wave inversion in the precordial lead has been described as Wellens' pattern ECG and correlates with coronary artery occlusion rather than acute pulmonary embolism [6,7].…”

Section: Introductionmentioning

confidence: 99%

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The Zurkurnai ECG Pattern: A Novel ECG Pattern of the High-Risk Features of Acute Pulmonary Embolism

Othman,

Yusof,

Ismail

et al. 2024

Cureus

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Acute pulmonary embolism is an important differential diagnosis in patients presenting with acute shortness of breath. However, the overlapping clinical presentation between acute coronary syndrome, aortic dissection, pneumonia, and heart failure made the diagnosis of pulmonary embolism very challenging in a limited resources center. We present a case of acute pulmonary embolism with an uncommon ECG pattern that was initially misdiagnosed as acute coronary syndrome. The authors made the appropriate diagnosis using the Zurkurnai ECG pattern in acute pulmonary embolism, which is defined as the presence of right axis deviation, deep symmetrical T wave inversion in V1 to V5, II, III, and AVF with the maximum at V3-V4 and poor R wave progression, which indicates the high-risk features of acute pulmonary embolism.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Zurkurnai ECG Pattern: A Novel ECG Pattern of the High-Risk Features of Acute Pulmonary Embolism

Othman,

Yusof,

Ismail

et al. 2024

Cureus

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“…13 Recently, Kusayama et al also indicated that T inversion in V3R lead is highly diagnostic for APE. 14 Beyond the diagnostic properties of ECG in patients with APE, evidence suggests that ECG abnormalities were independently associated with prognosis and survival rate of patients with APE. Sinus tachycardia in companion with signs of right ventricular dysfunction is associated with poor prognosis in patients with APE.…”

mentioning

confidence: 99%

“…13 Recently, Kusayama et al also indicated that T inversion in V3R lead is highly diagnostic for APE. 14…”

mentioning

confidence: 99%

Right-sided Electrocardiogram in Patients With Acute Pulmonary Embolism

Jahanian

Ayati

Hosseini

et al. 2021

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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Background: Acute pulmonary embolism (APE) is an emergent condition. The diagnostic tools are CT angiography and echocardiography. However, all of these modalities can be used under stable and nonemergent conditions. As electrocardiographic (ECG) studies are more feasible under emergent situations, Objective: we aimed to study right-sided ECG (RS-ECG) in patients with APE with further analysis regarding echocardiographic findings and pulmonary embolism severity index (PESI). Methods: Right-sided and standard electrocardiogram were obtained from 143 patients with confirmed APE. T-wave inversion, ST segment elevation (STE), and QS pattern in RS-ECG have been considered as abnormal changes. Results: T-wave inversion, STE, and QS pattern were found in 78.3%, 42%, and 39.9% of patients, respectively. 88.1% of patients showed at least one of these abnormalities in their RS-ECGs. Sensitivity of RS-ECG for APE was 0.88, which was higher than sensitivity of standard ECG (0.79). Patients with STE in right precordial leads, had increased right to left ventricular (RV/LV) diameter ratio (P = 0.021) and had higher PESI score (P = 0.000). Moreover, STE in RS-ECG was an independent predictor for PESI score in patients with moderate (odds ratio 4.05; 95% confidence interval [CI], 1.37-11.96; P < 0.05) and high 30-day mortality risk (odds ratio 8.42; 95% CI, 2.08-33.93; P < 0.05). Conclusions: Abnormal changes in RS-ECG were associated with an increase in RV/LV diameter ratio and higher PESI score, which may be indicated poor prognosis in patients with APE. The most clinically useful ECG finding was STE which was associated with increased RV/LV diameter ratio and PESI score.

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A Novel Electrocardiography Model for the Diagnosis of Acute Pulmonary Embolism

Ning

Yang

et al. 2022

Front. Cardiovasc. Med.

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Acute pulmonary embolism (acPE) is a severe disease that is often misdiagnosed as it is difficult to detect quickly and accurately. In this study, a novel electrocardiogram (ECG) model was used to estimate the probability of acPE rapidly via analysis of ECG characteristics. A total of 327 patients with acPE who were diagnosed at the Sichuan Provincial People's Hospital (SPPH) between 2018 and 2021 were retrospectively studied. A total of 331 patients were randomly selected as the control group, which included patients hospitalized during the same time period. The control group included patients who presented with characteristic symptoms of acPE, but this diagnosis was ruled out following further diagnostic testing. This study compared the diagnostic value of the ECG model with those of another ECG scoring model (Daniel-ECG score) and the most common prediction models (Wells score and Geneva score). This study established an ECG-predictive model using analysis of the ECG abnormalities in patients with acPE. The final ECG model included certain novel ECG signs that had not been incorporated in the previous ECG score of the patients, and thus, compared to the previous ECG score, exhibited a more favorable area under the receiver operating characteristic curve (AUC) value (0.8741). The model developed in this study was named the SPPH-ECG model. Furthermore, this study compared the SPPH-ECG model with Daniel-ECG score, Wells score, and Geneva score, and the SPPH-ECG model was demonstrated to exhibit a superior AUC value (0.8741), sensitivity (79.08%), negative predictive value (79.52%), and test accuracy (79.42%), while the Geneva score presented superior specificity (100%) and positive predictive value (100%) compared with the SPPH-ECG model. In conclusion, the SPPH-ECG model may play a role in ruling out acPE in patients during diagnostic testing and diagnose acPE rapidly and accurately in combination with the Geneva scoring system.

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Characteristics of synthesized right-sided chest electrocardiograms in patients with acute pulmonary embolism

Cited by 4 publications

References 33 publications

The Zurkurnai ECG Pattern: A Novel ECG Pattern of the High-Risk Features of Acute Pulmonary Embolism

The Zurkurnai ECG Pattern: A Novel ECG Pattern of the High-Risk Features of Acute Pulmonary Embolism

Right-sided Electrocardiogram in Patients With Acute Pulmonary Embolism

A Novel Electrocardiography Model for the Diagnosis of Acute Pulmonary Embolism

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