T-wave inversion in patients with acute pulmonary embolism: Prognostic value

Kukla, Piotr; McIntyre, William F.; Fijorek, Kamil; Długopolski, Robert; Mirek-Bryniarska, Ewa; Bryniarski, Krzysztof; Jastrzębski, Marek; Bryniarski, Leszek; Baranchuk, Adrián

doi:10.1016/j.hrtlng.2014.10.003

Cited by 23 publications

(25 citation statements)

References 16 publications

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“…The following are commonalities between the findings of our groups' studies and the studies by the Kukla's group [6,7,19]. First, STDV reflects worse prognosis compared to NTW.…”

Section: Discussionsupporting

confidence: 64%

“…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].…”

Section: Discussionmentioning

confidence: 75%

“…Incidentally, the LV subendocardial plus RV transmural ischemic pattern is the main ECG presentation (80%) in the high-risk APE patients [9] and signifies worse adverse clinical outcomes in this study. According to Kukla et al [19], the mortality rate was significantly higher in patients with NTW in the inferior and precordial leads compared to the group without NTW. In addition, as compared to those with NTW in < 5 leads, patients with NTW ≥ 5 leads experienced significantly higher rates of death and complications.…”

Section: Discussionmentioning

confidence: 97%

“…We did not find the number of leads with NTW to be associated with worse adverse clinical outcomes. This phenomenon may be attributed to a smaller number of patients in our study (210 vs. 470 patients) and methodological differences -we used the number of leads with NTW, while Kukla et al [19] used a cut-off of 5 leads in their analyses. In addition, our group used J-point as the measuring point of STDV while the Kukla's group used 80 ms after the J-point; this may account for further discrepancy between our studies.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2015

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Background: Common electrocardiogram (ECG) manifestations in acute pulmonary embolism (APE) include ST-segment deviation (STDV) along with negative T-waves (NTW). STDV could occur in 3 typical ischemic patterns: (i) the left ventricular (LV) subendocardial ischemic pattern; (ii) the right ventricular (RV) transmural ischemic pattern; and (iii) the LV intensification of therapy, and death compared to patients without STDV (p = 0.001 for each variable). The majority (89%) of the patients with STDV presented with 1 of the 3 typical ischemic ECG patterns. LV subendocardial ischemic pattern (OR = 4.963, p = 0.004), RV transmural ischemic pattern (OR = 3.128, p = 0.021) and LV subendocardial plus RV transmural ischemic pattern (OR = 3.036, p = 0.017) independently predicted the need to intensify therapy. RV transmural ischemic pattern (OR = 4.227, p = 0.031) and LV subendocardial plus RV transmural ischemic pattern (OR = 4.022, p = 0.032) (Cardiol J 2015; 22, 5: 583-589)

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“…The following are commonalities between the findings of our groups' studies and the studies by the Kukla's group [6,7,19]. First, STDV reflects worse prognosis compared to NTW.…”

Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

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

et al. 2015

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“…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.…”

Section: )mentioning

confidence: 99%

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

et al. 2018

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SummaryElectrocardiography (ECG) is used to screen for pulmonary hypertension (PH). However, it is unclear which parameters of ECG are the most useful for screening.ECG parameters related to right ventricular hypertrophy criteria were examined in 145 ECGs of subjects who were suspected to have PH and underwent right heart catheterization (RHC) (age 58.4 ± 17.5 years, 112 women, mean pulmonary arterial pressure [MPAP] 35.4 ± 13.3 mmHg). Based on the results of RHC, 108 subjects had PH (56 pulmonary arterial hypertension [PAH] and 52 chronic thromboembolic pulmonary hypertension [CTEPH]).Fourteen of 17 ECG parameters in the present study were significantly associated with PH on univariate analysis. On multivariable logistic regression analysis, S wave depth in lead V5 (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.10-1.47) and depth of T wave inversion in lead V4 (OR 1.21, 95% CI 1.03-1.46) were independent predictors of MPAP !25 mmHg, and the cut-off values determined by receiver operating characteristic curve analyses were 0.42 mV and -0.28 mV, respectively.In conclusion, a deeper S wave in lead V5 and the presence of a wider extent of negative T waves in the precordial leads may be clinically simple and useful ECG parameters for screening for PH.(Int Heart J 2018; 59: 136-142) Key words: Pulmonary arterial hypertension, Chronic thromboembolic pulmonary hypertension P ulmonary hypertension (PH) causes pressure overload of the right ventricle (RV) with RV hypertrophy and dilatation, leading to right heart failure and premature death. Despite recent advances in management, the prognosis of PH patients is still poor, with a 3-year survival rate of 67%.

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

Qaddoura

Digby

Kabali

et al. 2017

Clinical Cardiology

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The role of electrocardiography (ECG) in prognosticating pulmonary embolism (PE) is increasingly recognized. ECG is quickly interpretable, noninvasive, inexpensive, and available in remote areas.We hypothesized that ECG can provide useful information about PE prognostication. We searched MEDLINE, EMBASE, Google Scholar, Web of Science, abstracts, conference proceedings, and reference lists through February 2017. Eligible studies used ECG to prognosticate for the main outcomes of death and clinical deterioration or escalation of therapy. Two authors independently selected studies; disagreement was resolved by consensus. Ad hoc piloted forms were used to extract data and assess risk of bias. We used a random-effects model to pool relevant data in meta-analysis with odds ratios (ORs) and 95% confidence intervals (CIs); all other data were synthesized qualitatively. Statistical heterogeneity was assessed using the I 2 value. We included 39 studies (9198 patients) in the systematic review. There was agreement in study selection (κ:0.91, 95% CI: 0.86-0.96). Most studies were retrospective; some did not appropriately control for confounders. ECG signs that were good predictors of a negative outcome included S1Q3T3 (OR:3.38, 95% CI: 2.46-4.66, P < 0.001), complete right bundle branch block (OR: 3.90, 95% CI: 2.46-6.20, P < 0.001), T-wave inversion (OR: 1.62, 95% CI: 1.19-2.21, P = 0.002), right axis deviation (OR: 3.24, 95% CI: 1.86-5.64, P < 0.001), and atrial fibrillation (OR: 1.96, 95% CI: 1.45-2.67, P < 0.001) for in-hospital mortality. Several ischemic patterns also were significantly predictive.Our conclusion is that ECG is potentially valuable in prognostication of acute PE.

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T-wave inversion in patients with acute pulmonary embolism: Prognostic value

Cited by 23 publications

References 16 publications

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

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

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

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

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