Clinical Significance of ST Elevation in Lead aVR in Acute Pulmonary Embolism

Pourafkari, Leili; Ghaffari, Samad; Tajlil, Arezou; Akbarzadeh, Fariborz; Jamali, Farin

doi:10.1111/anec.12368

Cited by 11 publications

(10 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…17 In addition, ST segment elevation in AVR lead has been significantly associated with poor prognosis in APE patients. 18 This finding was in concordance with the results of another study, which stated that ischemic patterns (ie, ST segment elevation in AVR, ST segment depression in lateral leads, and inverted T waves) were significantly associated with worsen in-hospital outcomes. 19 Therefore, we aimed to assess the electrocardiographic changes in right precordial and also standard leads in patients with proved APE.…”

supporting

confidence: 91%

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

View full text Add to dashboard Cite

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.

show abstract

supporting

confidence: 91%

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

View full text Add to dashboard Cite

show abstract

“…These relations between STE in aVR and increased risk of adverse outcomes could be explained by the association of STE in aVR with severe underlying coronary disease such as LM disease or three vessels disease. It should also be noted that STE in aVR can be observed in many other clinical diseases such as acute pulmonary embolism (Pourafkari et al., 2017), myocardial hypertrophy, and acute aortic dissection (Kosuge et al., 2016).…”

Section: Discussionmentioning

confidence: 99%

Prognostic implications of ST‐segment elevation in lead aVR in patients with acute coronary syndrome: A meta‐analysis

Wang

Singh

Duan

et al. 2020

Noninvasive Electrocardiol

View full text Add to dashboard Cite

Background ST‐segment elevation (STE) in lead aVR is a useful tool in recognizing patients with left main or left anterior descending coronary obstruction during acute coronary syndrome (ACS). The prognostic implication of STE in lead aVR on outcomes has not been established. Methods We performed a systematic search for clinical studies about STE in lead aVR in four databases including PubMed, EMBASE, Cochrane Library, and Web of Science. Primary outcome was in‐hospital mortality. Secondary outcomes included in‐hospital (re)infarction, in‐hospital heart failure, and 90‐day mortality. Results We included 7 studies with a total of 7,700 patients. The all‐cause in‐hospital mortality of patients with STE in lead aVR during ACS was significantly higher than that of patients without STE (OR: 4.37, 95% CI 1.63 to 11.68, p = .003). Patients with greater STE (>0.1 mV) in lead aVR had a higher in‐hospital mortality when compared to lower STE (0.05–0.1 mV) (OR: 2.00, 95% CI 1.11–3.60, p = .02), However, STE in aVR was not independently associated with in‐hospital mortality in ACS patients (OR: 2.72, 95% CI 0.85–8.63, p = .09). The incidence of in‐hospital myocardial (re)infarction (OR: 2.77, 95% CI 1.30–5.94, p = .009), in‐hospital heart failure (OR: 2.62, 95% CI 1.06–6.50, p = .04), and 90‐day mortality (OR: 10.19, 95% CI 5.27–19.71, p < .00001) was also noted to be higher in patients STE in lead aVR. Conclusions This contemporary meta‐analysis shows STE in lead aVR is a poor prognostic marker in patients with ACS with higher in‐hospital mortality, reinfarction, heart failure and 90‐day mortality. Greater magnitude of STE portends worse prognosis. Further studies are needed to establish an independent predictive role of STE in aVR for these adverse outcomes.

show abstract

“…Right axis deviation is also characteristic of APE and is represented by negative T waves in the inferior and precordial leads [ 5 ]. ECG findings also have prognostic utility in APE with findings of right heart strain and atrial arrhythmias portending a worse prognosis [ 2 , 3 , 6 ]. There is a paucity of data on STEs, apart from aVR elevation, in the setting of APE.…”

Section: Discussionmentioning

confidence: 99%

Unique ECG Findings in Acute Pulmonary Embolism: STE with Reciprocal Changes and Pathologic Q Wave

Grant-Orser

Ballantyne

Haddara

2018

Case Reports in Critical Care

View full text Add to dashboard Cite

A 68-year-old male presented to the emergency department with retrosternal chest pain, presyncope, and then a pulseless electrical activity cardiac arrest. An ECG prior to his arrest revealed ST elevations in leads V1–V3, Q waves in lead V2, and reciprocal ST depressions in the lateral and inferior leads. He received thrombolytic therapy for a presumptive diagnosis of ST elevation myocardial infarction. Return of spontaneous circulation was achieved and he underwent a coronary angiogram. No critical disease was found and his left ventriculogram showed normal contraction. His ongoing metabolic acidosis and dependence on an intra-aortic balloon pump, despite adequate cardiac output, prompted a CT pulmonary angiogram which showed multiple segmental filling defects. He was treated for a pulmonary embolism and was discharged 5 days later. Acute pulmonary embolism (APE) has variable clinical presentations. To our knowledge, this is the first case report of an APE presenting with these ECG findings suggestive of myocardial ischemia. In this case report, we discuss the underlying physiological mechanisms responsible and offer management suggestions for emergency department and critical care physicians to better expedite the treatment of APE mimicking acute coronary syndrome on ECG.

show abstract

Clinical Significance of ST Elevation in Lead aVR in Acute Pulmonary Embolism

Abstract: The presence of STE is indicative of hemodynamic instability, thereby having the ability to predict poor outcome. However, its impact on hospital mortality disappears when the presence of shock on admission is factored in the prediction model.

Cited by 11 publications

References 23 publications

Right-sided Electrocardiogram in Patients With Acute Pulmonary Embolism

Right-sided Electrocardiogram in Patients With Acute Pulmonary Embolism

Prognostic implications of ST‐segment elevation in lead aVR in patients with acute coronary syndrome: A meta‐analysis

Unique ECG Findings in Acute Pulmonary Embolism: STE with Reciprocal Changes and Pathologic Q Wave

Contact Info

Product

Resources

About