Increasing spatial ventricular gradient magnitude was associated with decreased odds of adverse events after acute pulmonary embolism (OR 0.32 per standard deviation increase; p=0.03).
Observational (n=317)
No
Does the spatial ventricular gradient (SVG) predict adverse outcomes better than traditional ECG markers in patients with acute pulmonary embolism?
The spatial ventricular gradient is a strong prognostic marker for adverse outcomes in acute pulmonary embolism, outperforming traditional ECG signs of right ventricular dysfunction.
Odds Ratio: 0.32
p-value: p=0.03
BACKGROUND: The spatial ventricular gradient (SVG) is a vectorcardiographic measurement that reflects cardiac loading conditions via electromechanical coupling. OBJECTIVES: We hypothesized that the SVG is correlated with right ventricular (RV) strain and is prognostic of adverse events in patients with acute pulmonary embolism (PE). METHODS: Retrospective, single-center study of patients with acute PE. Electrocardiogram (ECG), imaging, and outcome data were obtained. SVG components were regressed on tricuspid annular plane systolic excursion (TAPSE), qualitative RV dysfunction, and RV/left ventricular (LV) ratio. Odds of adverse outcomes (30-day mortality, vasopressor requirement, or advanced therapy) after PE were regressed on demographics, RV/LV ratios, traditional ECG signs of RV dysfunction, and SVG components using a logit model. RESULTS: ECGs from 317 patients (48% male, age 63.1 ± 16.6 years) with acute PE were analyzed; 36 patients (11.4%) experienced an adverse event. Worse RV hypokinesis, larger RV/LV ratio, and smaller TAPSE were associated with smaller SVG X and Y components, larger SVG Z components, and smaller SVG vector magnitude (p < .001 for all). In multivariable logistic regression, odds of adverse events after PE decreased with increasing SVG magnitude and TAPSE (OR 0.32 and 0.54 per standard deviation increase; p = .03 and p = .004, respectively). Receiver operating characteristic (ROC) analysis showed that, when combined with imaging, replacing traditional ECG criteria with the SVG significantly improved the area under the ROC from 0.70 to 0.77 (p = .01). CONCLUSION: The SVG is correlated with RV dysfunction and adverse outcomes in acute PE and has a better prognostic value than traditional ECG markers.
Stabenau et al. (Tue,) conducted a observational in Acute pulmonary embolism (n=317). Spatial ventricular gradient (SVG) vs. Traditional ECG markers was evaluated on Adverse outcomes (30-day mortality, vasopressor requirement, or advanced therapy) (OR 0.32, p=0.03). Increasing spatial ventricular gradient magnitude was associated with decreased odds of adverse events after acute pulmonary embolism (OR 0.32 per standard deviation increase; p=0.03).