Electrocardiography changes and their significance during treatment of patients with intermediate-high and high-risk pulmonary embolism

Abstract

Background: Electrocardiography (ECG) signs, typical or acute pulmonary embolism, and their changes can be used for the prediction of clinical and haemodynamic outcomes. Purpose: To study the predictive value of the resolution of admission ECG signs in higher risk pulmonary embolism patients for 30-day survival and for the decrease in right ventricular systolic pressure. Methods: We analysed the 12-lead ECGs at admission and daily for the first 5 days after hospitalisation in 110 intermediate-high and high-risk pulmonary embolism patients admitted to the intensive care unit of a single tertiary centre. The predictive value of the resolution of four ECG signs were analysed for 30-day survival and for the changes in right ventricular systolic pressure during hospitalisation: S-wave in the first standard lead, right bundle branch block pattern, S-wave in the aVL lead and negative T-waves in precordial leads. Results: ECG recordings showed the existence of S-wave in the I lead in 71 (64.5%), S-wave in the aVL in 77 (70%), right bundle branch block pattern in 30 (27.3%) and negative T-waves in 66 (60%) patients. All-cause 30-day in-hospital mortality was 13.6%. Among the ECG signs, only the presence of right bundle branch block at admission was significantly associated with 30-day all-cause mortality (hazard ratio (HR) adjusted for age, gender and right ventricular systolic pressure at admission was 7.7, 95% confidence interval (CI) 2.1–27.9; P=0.002). The resolution of three ECG signs during the first 5 days of hospitalisation, S-wave in the I lead (HR 26.4, 95% CI 3.1–226.6; P=0.003), S-wave in the aVL (HR 21.5, 95% CI 2.6–175.3; P=0.004) and right bundle branch block configuration (HR 5.2, 95% CI 1.3–20.8; P=0.020) were associated with 30-day survival. The intermediate-high and high-risk pulmonary embolism patients with S-wave resolution in lead aVL had 0.0% and 7.1% 30-day all-cause mortality, respectively. The patients with resolution of the S-wave in the first lead and in aVL as well as right bundle branch block had more pronounced changes in right ventricular systolic pressure at discharge (27±13 vs. 13±15 mmHg; P=0.011 for S-wave in I lead resolution, 27±12 vs. 15±17 mmHg; P=0.004 for S-wave in aVL resolution and 23±14 vs. 9±14 mmHg; P=0.040 for right bundle branch block resolution) than patients without resolution. Conclusion: Resolution of S-waves and right bundle branch block in ECG correlates with lower all-cause 30-day mortality in intermediate-high and high-risk pulmonary embolism patients. Resolution of S-waves in the first lead and in aVL and right bundle branch block correlates with a decrease of right ventricular systolic pressure.

Signs and symptoms of acute pulmonary embolism and their predictive value for all-cause hospital death in respect of severity of the disease, age, sex and body mass index: retrospective analysis of the Regional PE Registry (REPER)

“…ECG was performed on admission. The typical PE ECG signs were recorded (S1Q3T3 sign, right bundle branch block (RBBB), negative T-waves in the precordial leads, S-waves in the aVL and paroxysmal atrial fibrillation) 18…”

Electrocardiographic Changes after Endovascular Mechanical Thrombectomy in a Patient with Pulmonary Embolism—A Case Report and Literature Review

“…However, electrocardiographic PE signs are absent in about 15-40% of PE patients, particularly in milder courses [5,6,[8][9][10]. Nevertheless, some ECG changes (e.g., sinus tachycardia, SIQIII type, right bundle branch block and T wave inversions) have prognostic significance [5,8,9,[11][12][13]. A dreaded complication of PE is right heart failure, which can lead to subsequent death [1].…”

Risk stratification of normotensive pulmonary embolism: One more ride on the merry-go-round

“…8 Similarly, the single-centre study by Novicic et al found that the early resolution of specific ECG signs present at admission in 110 intermediate-high and high-risk patients were associated with better 30-day survival and lower right ventricular systolic pressure at discharge. 6 Several cohort studies from the past decade focused on disease-specific and comorbidity-oriented parameters that are strongly associated with early complications after acute pulmonary embolism. 9 Most of these parameters are pathophysiologically and clinically interrelated: therefore, it does not come as a surprise that different markers of cardiopulmonary function are equally good at predicting the course of disease.…”

“…9 Most of these parameters are pathophysiologically and clinically interrelated: therefore, it does not come as a surprise that different markers of cardiopulmonary function are equally good at predicting the course of disease. The studies published in the European Heart Journal -Acute Cardiovascular Care [4][5][6] remind us that pulmonary embolism is a multifaceted condition and a comprehensive assessment of organ function, clinical parameters and demographic characteristics may also translate into a better risk stratification.…”

“…In this issue of the European Heart Journal -Acute Cardiovascular Care, readers will find four studies contributing valuable information on key risk stratification concepts covering almost the whole spectrum of pulmonary embolism severity. [4][5][6] The low-risk end of the spectrum was addressed by studies that updated or expanded the Pulmonary Embolism Severity Index, the most widely used tool for the identification of potential candidates for home treatment and low-intensity care. Yamashita et al found that patients from the COntemporary ManageMent AND outcomes in patients with Venous ThromboEmbolism (COMMAND VTE) registry with a simplified Pulmonary Embolism Severity Index ((s)PESI) of zero, indicating lowrisk category, had a reasonably low 30-day mortality: two patients out of 383 (0.5%) died due to fatal pulmonary embolism and intracranial haemorrhage, respectively.…”