Key result
T-wave inversions in leads V1 to V3 detected right ventricular dysfunction in acute pulmonary embolism with 75% sensitivity and 95% specificity, outperforming cardiac biomarkers.
Why the study?
Does electrocardiography (specifically T-wave inversion in leads V1-V3) improve the early detection of right ventricular dysfunction compared to biomarkers in patients with acute pulmonary embolism?
Observational (n=48)
No
Does electrocardiography (specifically T-wave inversion in leads V1-V3) improve the early detection of right ventricular dysfunction compared to biomarkers in patients with acute pulmonary embolism?
p-value: p=<0.001
T-wave inversion in precordial leads V1-V3 is a highly specific and accurate bedside marker for detecting right ventricular dysfunction in acute pulmonary embolism, outperforming standard biomarkers.
Supports ECG T-wave inversions in V1-V3 for RV dysfunction detection in acute PE; hypothesis-generating and should not yet change practice.
BACKGROUND AND OBJECTIVES: Right ventricular (RV) dysfunction is associated with a poor prognosis in patients with an acute pulmonary embolism (APE). We studied the role of electrocardiography and biomarkers for early detection and recovery of right ventricular dysfunction (RVD) in APE. SUBJECTS AND METHODS: The medical records of 48 consecutive patients diagnosed with APE using CT-angiography, at the Kangdong Sacred Heart Hospital, between January 2004 and February 2008 were reviewed retrospectively. RVD was assessed by serial echocardiography (ECG). Patients with one of the following were considered to have RVD: 1) RV dilatation (enddiastolic diameter >30 mm in the parasternal long axis view), 2) RV free wall hypokinesia, and 3) paradoxical septal systolic motion. We compared the electrocardiographic findings and the biomarkers for the early detection of RVD. RESULTS: The electrocardiographic findings showed T-wave inversion (TWI) in leads V1 to V3 with a sensitivity of 75% and a specificity of 95%, and a diagnostic accuracy of 80% for the detection of RVD, with positive and negative predictive values of 95.5% and 73.1%, respectively; these results were better than the biomarkers such as cardiac enzymes or B-type natriuretic peptide (BNP) for the early detection of RVD. TWIs persisted throughout the period of RVD, in contrast to a transient S1Q3T3 pattern detected during the acute phase only. CONCLUSION: TWIs in leads V1 to V3 had the greatest sensitivity and diagnostic accuracy for early detection of RVD, and normalization of the TWIs was associated with recovery of RVD in APE.
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Kim et al. (2009) conducted an observational in Acute pulmonary embolism (n=48). T-wave inversion in leads V1 to V3 vs. Absence of T-wave inversion was evaluated on Detection of right ventricular dysfunction (p=<0.001). T-wave inversions in leads V1 to V3 detected right ventricular dysfunction in acute pulmonary embolism with 75% sensitivity and 95% specificity, outperforming cardiac biomarkers.
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