1. Prognostic value of ECG among patients with acute pulmonary embolism and normal blood pressure.
- Author
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Vanni S, Polidori G, Vergara R, Pepe G, Nazerian P, Moroni F, Garbelli E, Daviddi F, and Grifoni S
- Subjects
- Adolescent, Adult, Aged, Aged, 80 and over, Blood Pressure physiology, Echocardiography methods, Female, Fibrinolytic Agents administration & dosage, Heparin administration & dosage, Humans, Male, Middle Aged, Myocardium chemistry, Prognosis, Pulmonary Embolism diagnostic imaging, Pulmonary Embolism drug therapy, Troponin I analysis, Ventricular Dysfunction, Right diagnostic imaging, Ventricular Dysfunction, Right physiopathology, Young Adult, Electrocardiography methods, Pulmonary Embolism diagnosis, Pulmonary Embolism physiopathology
- Abstract
Objective: To investigate the prognostic value of electrocardiography (ECG) alone or in combination with echocardiography in patients with acute pulmonary embolism and normal blood pressure., Methods: Consecutive adult patients presenting to the emergency department at Azienda Ospedaliero-Universitaria Careggi with the first episode of pulmonary embolism were included. Patients with systolic blood pressure less than 100 mm Hg were excluded. ECG and echocardiography were performed within 1 hour from diagnosis and evaluated in a blinded fashion. Right ventricular strain was diagnosed in the presence of one or more of the following ECG findings: complete or incomplete right ventricular branch block, S1Q3T3, and negative T wave in V1-V4. The main outcome measurement was clinical deterioration or death during in-hospital stay. The association of variables with the main outcome was evaluated by multivariate Cox survival analysis., Results: A total of 386 patients with proved pulmonary embolism were included in the study; 201 patients (52%) had right ventricular dysfunction according to echocardiography, and 130 patients (34%) showed right ventricular strain. Twenty-three patients (6%) had clinical deterioration or died. At multivariate survival analysis, right ventricular strain was associated with adverse outcome (hazard ratio 2.58; 95% confidence interval, 1.05-6.36) independently of echocardiographic findings. Patients with both right ventricular strain and right ventricular dysfunction (26%) showed an 8-fold elevated risk of adverse outcome (hazard ratio 8.47; 95% confidence interval, 2.43-29.47)., Conclusion: Right ventricular strain pattern on ECG is associated with adverse short-term outcome and adds incremental prognostic value to echocardiographic evidence of right ventricular dysfunction in patients with acute pulmonary embolism and normal blood pressure.
- Published
- 2009
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