Relation of Electrocardiographic Changes in Pulmonary Embolism to Right Ventricular Enlargement

Stein, Paul D.; Matta, Fadi; Sabra, Michel J.; Treadaway, Brent; Vijapura, Chirag; Warren, Robert; Joshi, Parth; Sadiq, Muhammad Athar; Kofoed, J. Thomas; Hughes, Patrick G.; Chabala, Stephen D.; Keyes, Daniel C.; Kakish, Edward; Hughes, Mary J.

doi:10.1016/j.amjcard.2013.08.030

Cited by 27 publications

(29 citation statements)

References 11 publications

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“…An increased incidence of partial RBBB, T-wave inversion and J point elevation in lead V1 suggest changes in RV electrical activity, although we cannot directly link these to the degree of altered RV structure and function observed in echocardiographic indices in the current study and this is supported by findings in pulmonary embolism (Stein et al 2013). Kucher and colleagues (2003) presented similar 12-lead ECG findings in patients following pulmonary embolism and suggest that this was consistent with RV strain (Kucher et al 2003).…”

Section: Discussionsupporting

confidence: 71%

The right ventricle following ultra-endurance exercise: insights from novel echocardiography and 12-lead electrocardiography

et al. 2014

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Purpose: There is contradictory evidence related to the impact of ultra-marathon running on right ventricular (RV) structure and function. Consequently, the aims of this study were to; 1) comprehensively assess RV structure and function before and immediately following a 100 mile ultramarathon in highly trained runners, 2) determine the nature of RV recovery 6 hours post-race, and 3) document 12-lead electrocardiogram (ECG) changes post-exercise.Methods: Echocardiography and 12-lead ECG were assessed in 15 competitors in a repeated measures design before and immediately after completion of the 2013 Western States Endurance Race. A subset of 9 were reassessed 6 hours into recovery. Standard echocardiography was used to determine RV size, function and wall stress. Myocardial speckle tracking (MST) provided peak, time to peak and temporal indices for RV longitudinal strain and strain rates (ε and SR).Results: RV size was increased post-race (inflow tract 14 %, outflow tract 11 %, P = 0.004 and 0.002). RV wall stress was elevated by 11 % post-race. Peak RV ε was reduced by 10 % (P = 0.007) and significantly delayed post-race (P = 0.008). Most changes in RV function persisted at the 6 hour assessment. Post-race there was an increase in the prevalence of right-sided ECG changes. Conclusions:Completion of a 100 mile ultra-marathon resulted in acute changes in RV structure and function that persisted 6 hours into recovery and are consistent with sustained exposure to an elevated RV wall stress. These findings were supported by right sided changes to the 12-Lead ECG.

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Section: Discussionsupporting

confidence: 71%

The right ventricle following ultra-endurance exercise: insights from novel echocardiography and 12-lead electrocardiography

et al. 2014

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“…42 Sinus tachycardia has also been found to be more common in patients with RV enlargement than those without (29% vs 18%, P = 0.02). 19 Furthermore, sinus tachycardia may be more common in patients with acute PE than chronic PE (74% vs 51%, P = 0007), 45 as well as in pulmonary trunk embolism than peripheral embolism (100% vs 30%), though statistical significance was not calculated for the latter. 46 In terms of prognostication, sinus tachycardia has been shown to be more prevalent in patients with massive PE than nonmassive PE in one study (36% vs 0%), 37 but this finding was not replicated by Bircan et al 42 While some studies have shown that patients with sinus tachycardia are at increased risk of in-hospital complications (88% vs 19%, P = 0.0003; 65% vs 38%, P < 0.05) 38,41 and in-hospital death (91% vs 37%, P < 0.001), 41 several studies have found no significant association with either, 23,38,45 , nor with degree of cardiac biomarker elevation.…”

Section: Updated Evidence On the Value Of Ecg As A Prognostic Tool Ecmentioning

confidence: 99%

“…[10][11][12][13] ECG abnormalities in PE are being increasingly reported and characterized. 11,[14][15][16][17][18][19][20] Furthermore, mounting evidence suggests that ECG plays a valuable role in prognostication for PE, with various ECG abnormalities having been demonstrated to be reasonable predictors of hemodynamic decompensation, 20 RV dysfunction (RVD), 21 elevated mean pulmonary artery pressure (MPAP), 22 in-hospital complication, 17,23,24 cardiogenic shock, 18 and even mortality. 14,23,25,26 As such, a consensus paper on the role of ECG in the prognostication of PE is both timely and necessary.…”

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confidence: 99%

The Value of Electrocardiographic Abnormalities in the Prognosis of Pulmonary Embolism: A Consensus Paper

Digby

Kukla²,

Zhong-qun

et al. 2015

Noninvasive Electrocardiol

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Electrocardiographic (ECG) abnormalities in the setting of acute pulmonary embolism (PE) are being increasingly characterized and mounting evidence suggests that ECG plays a valuable role in prognostication for PE. We review the historical 21-point ECG prognostic score for the severity of PE and examine the updated evidence surrounding the utility of ECG abnormalities in prognostication for severity of acute PE. We performed a literature search of MEDLINE, EMBASE, and PubMed up to February 2015. Article titles and abstracts were screened, and articles were included if they were observational studies that used a surface 12-lead ECG as the instrument for measurement, a diagnosis of PE was confirmed by imaging, arteriography or autopsy, and analysis of prognostic outcomes was performed. Thirty-six articles met our inclusion criteria. We review the prognostic value of ECG abnormalities included in the 21-point ECG score, including new evidence that has arisen since the time of its publication. We also discuss the potential prognostic value of several ECG abnormalities with newly identified prognostic value in the setting of acute PE.

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“…They found that the ECG score was the independent predictor of RVSP. Stein et al 14 showed sensitivity, positive predictive value, and negative predictive value that were insufficient for the diagnosis or exclusion of RV enlargement in patients without cardiopulmonary disease. Sukhija et al 15 found similar results.…”

Section: Discussionmentioning

confidence: 99%

Association of different electrocardiographic patterns with shock index, right ventricle systolic pressure and diameter, and embolic burden score in pulmonary embolism

et al. 2016

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Relation of Electrocardiographic Changes in Pulmonary Embolism to Right Ventricular Enlargement

Cited by 27 publications

References 11 publications

The right ventricle following ultra-endurance exercise: insights from novel echocardiography and 12-lead electrocardiography

The right ventricle following ultra-endurance exercise: insights from novel echocardiography and 12-lead electrocardiography

The Value of Electrocardiographic Abnormalities in the Prognosis of Pulmonary Embolism: A Consensus Paper

Association of different electrocardiographic patterns with shock index, right ventricle systolic pressure and diameter, and embolic burden score in pulmonary embolism

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