Prognostic Significance of Inverted T Waves in Patients With Acute Pulmonary Embolism

Abstract

Background The significance of inverted T waves remains unclear in patients with acute pulmonary embolism (PE). Methods and ResultsThe relationship of the number of leads with inverted T waves to the severity of PE in 40 patients with acute PE was studied. Patients were classified into 3 groups according to the number of leads with inverted T waves on the admission electrocardiogram (ECG): 15 patients, ≤3 leads (group L); 12 patients, 4-6 leads (group M); and 13 patients, ≥7 leads (group H). In groups L, M and H, the rates of right ventricular dysfunction on echocardiography were 47%, 92% and 100% (p<0.01), respectively, and the rates of in-hospital complicated events (including death or the need for catecholamine support, cardiopulmonary resuscitation or mechanical cardiovascular support because of hemodynamic instability) were 0%, 8% and 46% (p=0.004), respectively. On multivariate analysis, arterial hypotension at presentation (odds ratio (OR) 8.96, p=0.049) and inverted T waves in ≥7 leads on the admission ECG (OR 16.8, p=0.037) were the only independent predictors of in-hospital complicated events. Conclusions The number of leads with inverted T waves may be a useful and simple marker of increased risk for early complications in patients with acute PE. (Circ J 2006; 70: 750 -755)

Significance of ST-segment deviation in patients with acute pulmonary embolism and negative T waves

“…We also speculate [14] and in patients who were not treated for APE [3,5]. More leads with NTW are also related to worse short-term prognosis [18,19]. However, there is a poor relationship in patients after effective treatment where the RVD has possibly been recovered [14,17].…”

Deeper S Wave in Lead V5 and Broader Extent of T Wave Inversions in the Precordial Leads are Clinically Useful Electrocardiographic Parameters for Predicting Pulmonary Hypertension

“…24) Furthermore, an increasing number of leads with T wave inversion was related to a higher mortality rate and a higher frequency of complications. 25,26) A possible mechanism of T wave inversion is acute cor pulmonale with rapid right ventricular pressure overload and right ventricular enlargement, although it is not completely understood. In 44 patients with CTEPH, Lewzcuk, et al reported that a negative T wave in the precordial V1-V5 leads was most commonly observed (45.4%) as an ECG sign of right ventricular overload, and the sensitivity and specificity for detecting MPAP > 30 mmHg were 48.0% and 95.0%, respectively.…”

Usefulness of Decreasing Number of Negative T Wave Leads on Electrocardiography for Predicting the Improvement of Pulmonary Hypertension

“…reported a significant association between the number of negative T wave leads and the severity of pulmonary thromboembolism 11) . In present case, the number of negative T wave leads on ECG gradually declined from left-to right-sided leads of horizontal plane and leftward to rightward axis of the frontal plane of the heart according to the improvement of right heart overload.…”