Key result
Specific ECG patterns link to higher RV strain, embolic burden, and hemodynamic instability in PE.
Why the study?
The exact meaning of different electrocardiographic signs in pulmonary embolism is not well known.
Do specific ECG patterns correlate with shock index, right ventricular parameters, and embolic burden in patients with pulmonary embolism?
Observational (n=130)
No
Do specific ECG patterns correlate with shock index, right ventricular parameters, and embolic burden in patients with pulmonary embolism?
p-value: p=<0.001
Specific admission ECG patterns in pulmonary embolism correlate with distinct clinical and imaging parameters, such as RBBB with shock and S-waves in aVL with right ventricular pressure.
ECG signs in PE may link to SI and RVDD; hypothesis-generating for risk stratification, prospective validation required.
Background/Aim: Some electrocardiographic (ECG) patterns are characteristic for pulmonary embolism but exact meaning of the different ECG signs are not well known. The aim of this study was to determine the association between four common ECG signs in pulmonary embolism [complete or incomplete right bundle branch block (RBBB), S-waves in the aVL lead, S1Q3T3 sign and negative T-waves in the precordial leads] with shock index (SI), right ventricle diastolic diameter (RVDD) and peak systolic pressure (RVSP) and embolic burden score (EBS). Methods: The presence of complete or incomplete RBBB, S waves in aVL lead, S1Q3T3 sign and negative T-waves in the precordial leads were determined at admission ECG in 130 consecutive patients admitted to the intensive care unit of a single tertiary medical center in a 5-year period. Echocardiography examination with measurement of RVDD and RVSP, multidetector computed tomography pulmonary angiography (MDCT-PA) with the calculation of EBS and SI was determined during the admission process. Multivariable regression models were calculated with ECG parameters as independent variables and the mentioned ultrasound, MDCT-PA parameters and SI as dependent variables. Results: The presence of S-waves in the aVL was the only independent predictor of RVDD (F = 39.430, p < 0.001; adjusted R2 = 0.231) and systolic peak right ventricle pressure (F = 29.903, p < 0.001; adjusted R2 = 0.185). Negative T-waves in precordial leads were the only independent predictor for EBS (F = 24.177, p < 0.001; R2 = 0.160). Complete or incomplete RBBB was the independent predictor of SI (F = 20.980, p < 0.001; adjusted R2 = 0.134). Conclusion: In patients with pulmonary embolism different ECG patterns at admission correlate with different clinical, ultrasound and MDCT-PA parameters. RBBB is associated with shock, Swave in the aVL is associated with right ventricle pressure and negative T-waves with the thrombus burden in the pulmonary tree.
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Krca et al. (2016) conducted an observational in pulmonary embolism (n=130). Electrocardiographic patterns (RBBB, S-waves in aVL, S1Q3T3, negative T-waves in precordial leads) was evaluated on Shock index, right ventricle diastolic diameter, peak systolic pressure, and embolic burden score (p=<0.001). In patients with pulmonary embolism, S-waves in aVL predicted right ventricle pressure (P<0.001), negative T-waves predicted embolic burden (P<0.001), and RBBB predicted shock index (P<0.001).
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