The prognostic value of ECG-derived ventricular gradient in early adverse events in acute pulmonary embolism patients

Risk-stratification in pulmonary embolism (PE) includes clinical decision rules, biomarkers and signs of right ventricular (RV) overload. The vector electrocardiogram is a diagnostic tool in which the ECG-derived ventricular gradient optimized for right ventricular pressure overload (VG-RVPO) can be used to detect patients with increased pulmonary pressure. The primary aim of this study was to assess the association of VG-RVPO and CT-assessed RV/LV diameter ratio as well as the prognostic value of an abnormal VG-RVPO for early adverse events in PE patients. In this single-center retrospective study, adult patients with acute PE were identified via the hospital’s administrative system. Adverse events were defined as the combined outcome of 30-day overall mortality, recurrent venous thromboembolism, the need for mechanical ventilation, the need for inotropic or vasopressive therapy and/or cardiac resuscitation. VG-RVPO analysis was available for 164 patients diagnosed with PE between December 2015 and September 2018. Abnormal VG-RVPO was associated with a CTPA-assessed RV/LV diameter ratio >1.0 (OR 2.0; 95%CI 1.0–3.9). The adverse 30-day composite outcome occurred in 16 of 66 patients (24%) with abnormal VG-RVPO compared to 22 of 98 patients (22%) with normal VG-RVPO (OR 1.1, 95%CI 0.53–2.3). The net reclassification improvement of VG-RVPO on top of RV dilatation for predicting early adverse events was -12%, indicating no additional prognostic value of VG-RVPO on top of RV/LV diameter ratio. Although we observed an association between RV dilatation, abnormal ECG-derived VG-RVPO was not associated with acute PE associated adverse events.