Electrocardiography Patterns and the Role of the Electrocardiography Score for Risk Stratification in Acute Pulmonary Embolism

Abstract

Background and ObjectivesData on the usefulness of a combination of different electrocardiography (ECG) abnormalities in risk stratification of patients with acute pulmonary embolism (PE) are limited. We thus investigated 12-lead ECG patterns in acute PE to evaluate the role of the ECG score in risk stratification of patients with acute PE.Subjects and MethodsOne hundred twenty-five consecutive patients (63±14 years, 56 men) with acute PE who were admitted to Kyungpook National University Hospital between November 2001 and January 2008 were included. We analyzed ECG patterns and calculated the ECG score in all patients. We evaluated right ventricular systolic pressure (RVSP) (n=75) and RV hypokinesia (n=80) using echocardiography for risk stratification of acute PE patients.ResultsAmong several ECG findings, sinus tachycardia and inverted T waves in V1-4 (39%) were observed most frequently. The mean ECG score and RVSP were 7.36±6.32 and 49±21 mmHg, respectively. The ECG score correlated with RVSP (r=0.277, p=0.016). The patients were divided into two groups {high ECG-score group (n=38): ECG score >12 and low ECG-score group (n=87): ECG score ≤12} based on the ECG score, with the maximum area under the curve. RV hypokinesia was observed more frequently in the high ECG-score group than in the low ECG-score group (p=0.006). Multivariate analysis revealed that a high ECG score was an independent predictor of high RVSP and RV hypokinesia.ConclusionSinus tachycardia and inverted T waves in V1-4 were commonly observed in acute PE. Moreover, the ECG score is a useful tool in risk stratification of patients with acute PE.

The value of electrocardiography in prognosticating clinical deterioration and mortality in acute pulmonary embolism: A systematic review and meta‐analysis

“…Twenty studies (4898 patients) reported data on in‐hospital mortality . Several ECG features were meta‐analyzed for this outcome (Table ).…”

“…Ermis et al reported median (IQR) for the Daniel score and found a significantly higher Daniel score for patients who died: 6.0 (7.0) vs 4.0 (4.0), P = 0.007. Ryu et al used a Daniel score cutoff of 12 and found that 3/38 (8%) of those in the high‐ECG score group died, whereas 12/87 (14%) of those in the low‐ECG group died ( P = 0.55).…”

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Acute massive pulmonary embolism after radiofrequency catheter ablation: A rare complication after a common procedure

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Electrocardiographic Changes in a Patient With Pulmonary Embolism and Septic Shock

“…Several ECG changes have been identified in patients with pulmonary embolism (PE) 1). Precordial ST segment elevation has been previously described in patients with extensive PE 2)3).…”