scholarly journals ECG in suspected pulmonary embolism

2019 ◽  
Vol 95 (1119) ◽  
pp. 12-17 ◽  
Author(s):  
Duncan Thomson ◽  
Georgios Kourounis ◽  
Rebecca Trenear ◽  
Claudia-Martina Messow ◽  
Petr Hrobar ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Hospital Setting ◽  
District General Hospital ◽  
Diagnostic Value ◽  
Suspected Pulmonary Embolism ◽  
Ecg Changes ◽  
Retrospective Case ◽  
Strain Pattern ◽  
Pulmonary Angiogram ◽  
Large Clot

ObjectiveTo establish the diagnostic value of prespecified ECG changes in suspected pulmonary embolism (PE).MethodsRetrospective case–control study in a district general hospital setting. We identified 189 consecutive patients with suspected PE whose CT pulmonary angiogram (CTPA) was positive for a first PE and for whom an ECG taken at the time of presentation was available. We matched these for age±3 years with 189 controls with suspected PE whose CTPA was negative. We considered those with large (n=76) and small (n=113) clot load separately. We scored each ECG for the presence or absence of eight features that have been reported to occur more commonly in PE.Results20%–25% of patients with PE, including those with large clot load, had normal ECGs. The most common ECG abnormality in patients with PE was sinus tachycardia (28%). S1Q3T3 (3.7%), P pulmonale (0.5%) and right axis deviation (4.2%) were infrequent findings. Right bundle branch block (9.0%), atrial dysrhythmias (10.1%) and clockwise rotation (20.1%) occurred more frequently but were also common in controls. Right ventricular (RV) strain pattern was significantly more commonly in patients than controls, 11.1% vs 2.6% (sensitivity 11.1%, specificity 97.4%; OR 4.58, 95% CI 1.63 to 15.91; p=0.002), particularly in those with large clot load, 17.1% vs 2.6% (sensitivity 17.1%, specificity 97.4%; OR 7.55, 95% CI 1.62 to 71.58; p=0.005).ConclusionAn ECG showing RV strain in a breathless patient is highly suggestive of PE. Many of the other ECG changes that have been described in PE occur too infrequently to be of predictive value.

P2426Validating the diagnostic value of a machine learning algorithm for STEMI detection

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mehta ◽  
R Botelho ◽  
F Fernandez ◽  
C Villagran ◽  
A Frauenfelder ◽  
...  
Keyword(s):  
Medical Information ◽  
Learning Algorithm ◽  
Artery Bypass ◽  
Hospital Setting ◽  
Coronary Intervention ◽  
Diagnostic Value ◽  
Retrospective Case ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
The Right

Abstract Background We have previously reported the use of Artificial Intelligence (AI) guided EKG analysis for detection of ST-Elevation Myocardial Infarction (STEMI). To demonstrate the diagnostic value of our algorithm, we compared AI predictions with reports that were confirmed as STEMI. Purpose To demonstrate the absolute proficiency of AI for detecting STEMI in a standard12-lead EKG. Methods An observational, retrospective, case-control study. Sample: 5,087 EKG records, including 2,543 confirmed STEMI cases obtained via feedback from health centers following appropriate patient management (thrombolysis, primary Percutaneous Coronary Intervention (PCI), pharmacoinvasive therapy or coronary artery bypass surgery). Records excluded patient and medical information. The sample was derived from the International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (53,667 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample were used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVIDIA GTX 1070 GPU, 8GB RAM. Results The model yielded an accuracy of 97.2%, a sensitivity of 95.8%, and a specificity of 98.5%. Conclusion(s) Our AI-based algorithm can reliably diagnose STEMI and will preclude the role of a cardiologist for screening and diagnosis, especially in the pre-hospital setting.

Syncope in pulmonary embolism: a retrospective cohort study

2020 ◽  
pp. postgradmedj-2020-138677
Author(s):  
Craig Richmond ◽  
Hannah Jolly ◽  
Chris Isles
Keyword(s):  
Pulmonary Embolism ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
District General Hospital ◽  
Clinical Feature ◽  
Pulmonary Angiogram ◽  
Ct Pulmonary Angiogram ◽  
Age Range ◽  
Symptoms And Signs

ObjectiveTo determine the prevalence of syncope or collapse in pulmonary embolism (PE).MethodsA retrospective cohort study was conducted. We examined the frequency with which syncope or collapse (presyncope) occurred alone or with other symptoms and signs in an unselected series of 224 patients presenting to a district general hospital with PE between September 2012 and March 2016. Confirmation of PE was by CT pulmonary angiogram in each case.ResultsOur cohort of 224 patients comprised 97 men and 127 women, average age 66 years with age range of 21–94 years. Syncope or collapse was one of several symptoms and signs that led to a diagnosis of PE in 22 patients (9.8%) but was never the sole presenting feature. In descending order, these other clinical features were hypoxaemia (17 patients), dyspnoea (12), chest pain (9), tachycardia (7) and tachypnoea (7). ECG abnormalities reported to occur more commonly in PE were found in 13/17 patients for whom ECGs were available. Patients with PE presenting with syncope or collapse were judged to have a large clot load in 15/22 (68%) cases.ConclusionSyncope was a frequent presenting symptom in our study of 224 consecutive patients with PE but was never the sole clinical feature. It would be difficult to justify routine testing for PE in patients presenting only with syncope or collapse.

Diagnostic value of the electrocardiogram in suspected pulmonary embolism

2000 ◽  
Vol 86 (7) ◽  
pp. 807-809 ◽  
Author(s):  
Marc Rodger ◽  
Dimitri Makropoulos ◽  
Michele Turek ◽  
Jean Quevillon ◽  
Francois Raymond ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Diagnostic Value ◽  
Suspected Pulmonary Embolism

scholarly journals The diagnostic value of cyclophilin A and VAP-1 in patients with suspected pulmonary embolism

2018 ◽  
Vol 10 (3) ◽  
pp. 228-233
Author(s):  
Aynur Sahin ◽  
Olgun Asik ◽  
Ozgur Tatli ◽  
Yunus Karaca ◽  
Selim Demir ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cyclophilin A ◽  
Diagnostic Value ◽  
Suspected Pulmonary Embolism

scholarly journals Chest X-Ray Not Routinely Indicated Prior to the YEARS Algorithm in the Diagnostic Management of Suspected Pulmonary Embolism

TH Open ◽  
2019 ◽  
Vol 03 (01) ◽  
pp. e22-e27 ◽  
Author(s):  
Liselotte van der Pol ◽  
Cecile Tromeur ◽  
Laura Faber ◽  
Tom van der Hulle ◽  
Lucia Kroft ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Final Diagnosis ◽  
Diagnostic Value ◽  
Routine Care ◽  
Diagnostic Process ◽  
Unexpected Finding ◽  
Suspected Pulmonary Embolism ◽  
Likelihood Ratios ◽  
X Ray ◽  
Chest X Ray

Background The YEARS algorithm was designed to simplify the diagnostic process of suspected pulmonary embolism (PE) and to reduce the number of required computed tomography pulmonary angiography (CTPA) scans. Chest X-ray (CXR) is often used as initial imaging test in patients suspected for PE. Aim To determine if CXR results differ between patients with confirmed PE and with PE ruled out, and to investigate whether CXR provides incremental diagnostic value to the YEARS criteria that is used for selecting patients with CTPA indication. Methods This post-hoc analysis concerned 1,473 consecutive patients with suspected PE who were managed according to YEARS and were subjected to CXR as part of routine care. The prevalence and likelihood ratios of seven main CXR findings for a final diagnosis of PE were calculated. Results A total of 214 patients were diagnosed with PE at baseline (15%). Abnormal CXR occurred more often in patients with confirmed PE (36%, 77/214) than in patients without PE (26%; 327/1,259), for an odds ratio of 1.60 (95% confidence interval: 1.18–2.18). Only the unexpected finding of a (rib)fracture or pneumothorax, present in as few as six patients (0.4%), significantly lowered the post-test probability of PE to an extent that CTPA could have been avoided. Conclusion The incremental diagnostic value of CXR to the YEARS algorithm to rule out PE was limited. CXR was more frequently abnormal in patients with PE than in those in whom PE was ruled out. These data do not support to perform CXR routinely in all patients with suspected PE, prior to CTPA imaging.

IMPROVING COMPUTED TOMOGRAPHY PULMONARY ANGIOGRAM (CTPA) UTILIZATION IN SUSPECTED PULMONARY EMBOLISM

CHEST Journal ◽  
2009 ◽  
Vol 136 (4) ◽  
pp. 13S
Author(s):  
Guy W. Soo Hoo ◽  
Carol C. Wu ◽  
Sondra Vazirani ◽  
Zhaoping Li ◽  
Bruce M. Barack
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Suspected Pulmonary Embolism ◽  
Pulmonary Angiogram

scholarly journals CT Pulmonary Angiogram with Reduced Radiation Exposure at Low Tube Kilovoltage

2020 ◽  
Vol 14 (2) ◽  
Author(s):  
Ahmed Abdullahi Hashi
Keyword(s):  
Pulmonary Embolism ◽  
Radiation Dose ◽  
Contrast Enhancement ◽  
Low Dose ◽  
Reconstruction Algorithm ◽  
Diagnostic Value ◽  
Considerable Decrease ◽  
Low Tube Voltage ◽  
Pulmonary Angiogram ◽  
Group B

This study's primary goal is to assess the image quality and radiation dose of the low-dose 80kV computed tomography pulmonary angiogram (CTPA) protocol compared to the standard 100kV CTPA protocol for the assessment of pulmonary embolism (PE). The study consisted of 100 patients who had clinically suspected pulmonary embolism and required a CTPA. Patients underwent imaging with a 320-row multi-detector Toshiba Aquilion One Genesis Edition in the absence of the proprietary radiation reduction software known as forward projected model-based Iterative Reconstruction Solution (commercial acronym 'FIRST'). Participants were divided into two groups: A and B.  Group A was composed of 50 patients who were allocated to standard CT protocol using a 100 kV exposure setting and all other settings set as a standard by the manufacturer.  Group B was composed of 50 patients who were allocated to a CTPA with a low-dose 80kV protocol, standard deviation level 8, an effective mAs of 258, reconstruction algorithm-kernel FC 51 within the lung window, and tube current modulation. A considerable decrease in radiation dose was observed with the low-dose CTPA protocol. The mean radiation dose was also decreased by 66% while using the 80kV protocol than when utilising a standard 100kV technique; this was achieved without compromising this study's diagnostic value. Furthermore, the contrast enhancement was considerably more significant, up to 40% higher when using 80kV. The study found that a low tube voltage of 80kV CTPA protocol resulted in a considerable decrease in radiation dose and improved contrast enhancement without sacrificing the examinations' diagnostic utility.

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