scholarly journals Prognostic Value of ECG in Patients with Pulmonary Embolism

2019 ◽  
Vol 15 (1) ◽  
pp. 63-68
Author(s):  
I. S. Mullova ◽  
T. V. Pavlova ◽  
S. M. Khokhlunov ◽  
D. V. Duplyakov
Keyword(s):  
Pulmonary Embolism ◽  
Prognostic Value ◽  
Ventricular Dysfunction ◽  
Fatal Outcome ◽  
Right Ventricular Dysfunction ◽  
Pulmonary Angiography ◽  
Cardiac Biomarkers ◽  
St Segment Elevation ◽  
T Wave ◽  
St Segment

Aim. To study the significance of electrocardiography (ECG) signs for determining the hospital prognosis in patients with pulmonary embolism (PE).Material and methods. 472 consecutive patients (49.6% men; average age 58.06±14.28 years) with PE, hospitalized to our center from 23.04.2003 to 18.09.2014 were enrolled into the study. In all cases PE was confirmed by computed tomographic pulmonary angiography and rarely by pulmonary angiography, or by pathology. Patients management was in accordance with appropriate European guidelines. Data of patients' history, clinical symptoms, biochemical markers and instrumental methods (ECG, echocardiography) were analyzed by one-dimensional logistic regression. The end points were: death, shock and hypotension, right ventricular dysfunction and pulmonary hypertension, positive cardiac biomarkers.pulmonary embolism, electrocardiography, prognosis, collapse, hypotension, dysfunction of the right ventricle. 443 patients (93.9%) without fatal outcome were the first group and 29 patients (6.1%) with a fatal outcome – the second group. SIQIII pattern (33 vs 55.2%; p=0.015), non-complete right bundle branch block (RBBB) (16.3 vs 37.9%; p=0.001), ST segment elevation in lead III (9.7 vs 20.7%, p=0.034), atrial fibrillation (12.9 vs 37.9%, p=0.048) were observed more frequently among patients of group 2. Multivariate analysis revealed that SIQIII pattern (odds ratio [OR] 2.26; 95% confidence interval [95%CI] 1.046-4.868; p=0.038) and RBBB (OR 2.84; 95%CI 1.272-6.327; p=0.011) were associated with worse prognosis. The SIQIII pattern was significantly associated with a fatal outcome with a sensitivity of 55% and a specificity of 33% (AUC=0.611) according to ROC-analysis. Risk of hypotension was related to the following ECG-signs: the p-pulmonale (OR 1.76; 95%CI 1.001-3.088; p=0.049), negative T-wave in lead III (OR 1.8; 95%CI 1.035-3.144; p=0.037). Inversion of the T wave in lead III was associated with the development of shock (OR 1.98; 95%CI 0.891-4.430; p=0.043).ECG-signs were also associated with the development of right ventricular dysfunction and pulmonary hypertension: right axis deviation (OR 1.035; 95%CI 1.008-1.062; p=0.01), ST-segment elevation in the AVR lead (OR 3.769; 95%CI 1.018-13.955; p=0.047), negative T wave in leads III, V1-V3 (OR 1.015; 95%CI 1.008-1.023; p=0.001 and OR 1.014; 95%CI 1.005-1.022; p=0.001, respectively), RBBB (OR 1.013; 95%CI 1.003- 1.024; p=0.012), p-pulmonale (OR 1.015; 95%CI 1.007-1.023; p=0.001), deep S in leads V5-V6 (OR 1.015; 95%CI 1.006-1.024; p=0.001). However, there was no significant relationship between ECG signs and cardiac biomarkers (troponin I and BNP).Conclusions. SIQIII pattern, RBBB and inversion of the T wave in lead III have prognostic value in unselected population of patients with PE. 

scholarly journals Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis

2018 ◽  
Vol 40 (11) ◽  
pp. 902-910 ◽  
Author(s):  
Stefano Barco ◽  
Seyed Hamidreza Mahmoudpour ◽  
Benjamin Planquette ◽  
Olivier Sanchez ◽  
Stavros V Konstantinides ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Prognostic Value ◽  
Ventricular Dysfunction ◽  
Meta Analysis ◽  
Right Ventricular Dysfunction ◽  
Low Risk ◽  
Cardiac Biomarkers

P4369Direct comparison of prognostic value of echocardiographic parameters of right ventricular dysfunction in normotensive patients with acute pulmonary embolism

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Kurnicka ◽  
M Ciurzynski ◽  
L Hobohm ◽  
A Thielmann ◽  
B Sobkowicz ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Regression Analysis ◽  
Prognostic Value ◽  
Acute Pulmonary Embolism ◽  
Ventricular Dysfunction ◽  
Cox Regression ◽  
Clinical Course ◽  
Right Ventricular Dysfunction ◽  
Cox Regression Analysis ◽  
Echocardiographic Parameters

Abstract Background Although various echocardiographic parameters of right ventricular dysfunction (RVD) were reported to be of prognostic value in normotensive patients with acute pulmonary embolism (APE), an optimal definition of RVD on echocardiography is missing. Purpose We performed a direct comparison of prognostic value of RV/LV ratio, TAPSE, and TRPG/TAPSE for complicated clinical course that included: in-hospital APE related mortality, hemodynamic collapse or rescue thrombolysis. Methods Prospective cohorts of APE patients normotensive at admission, managed according to the ESC Guidelines 2014 were merged in a collaborative database. Transthoracic echocardiography was performed at admission, as soon as possible. All studied parameters were available in each patient. AUC in ROC analysis were assessed for each parameter and were compared between them. Multivariable Cox regression analysis was performed to assess the combination of echo-parameters. Results Overall, 490 pts were included in the study (229F), aged 64±18 years. Clinical endpoint occurred in 31 pts including 8 APE related deaths. AUC for SAE of RV/LV, TAPSE and TRPG/TAPSE were similar (Figure 1). TAPSE <16mm compared to other echo-parameters showed the highest PPV and NPV (Table 1). Cox regression analysis including SBP, HR, age, elevated troponin and echo-parameters showed that only blood pressure, RV/LV >1 and TAPSE <16mm were identified as independent predictors of outcome (HR 0.98 (95% CI: 0.96–0.99), p=0.03; 2,53 (95% CI: 1.2–5.7), p<0.03 and 3,76 (95% CI: 1.74–8.11), p<0.001). Table 1. Predictive values of proposed cut offs of echocardiographic parameters Parameter Sensitivity Specificity PPV NPV TAPSE <16mm 52% 85% 18% 96% RV/LV >1.0 74% 63% 12% 95% TAPSE<20 & TRPG/TAPSE >4.5 10% 94% 10% 94% Figure 1 Conclusions Although all TAPSE, RV/LV ratio and TRPG/TAPSE showed similar performance for prognosticating of in-hospital outcome in normotensive PE patients, TAPSE<16mm showed the highest predictive value for identification of patients at risk of complicated clinical course.

scholarly journals Risk stratification in normotensive acute pulmonary embolism patients: focus on the intermediate–high risk subgroup

2019 ◽  
Vol 9 (4) ◽  
pp. 279-285 ◽  
Author(s):  
Ana Rita Santos ◽  
Pedro Freitas ◽  
Jorge Ferreira ◽  
Afonso Oliveira ◽  
Mariana Gonçalves ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Risk Stratification ◽  
Right Ventricular ◽  
Acute Pulmonary Embolism ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Cardiac Biomarkers ◽  
Cardiac Biomarker ◽  
Imaging Signs

Background: Patients with acute pulmonary embolism are at intermediate–high risk in the presence of imaging signs of right ventricular dysfunction plus one or more elevated cardiac biomarker. We hypothesised that intermediate–high risk patients with two elevated cardiac biomarkers and imaging signs of right ventricular dysfunction have a worse prognosis than those with one cardiac biomarker and imaging signs of right ventricular dysfunction. Methods: We analysed the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction in 525 patients with intermediate risk pulmonary embolism (intermediate-high risk = 237) presenting at the emergency department in two centres. Studied endpoints were composites of all-cause mortality and/or rescue thrombolysis at 30 days (primary endpoint; n=58) and pulmonary embolism-related mortality and/or rescue thrombolysis at 30 days (secondary endpoint; n=40). Results: Patients who experienced the primary endpoint showed a higher proportion of elevated troponin (47% vs. 76%, P<0.001), elevated N-terminal pro-brain natriuretic peptide (67% vs. 93%, P<0.001) and imaging signs of right ventricular dysfunction (47% vs. 80%, P<0.001). Multivariate analysis revealed N-terminal pro-brain natriuretic peptide (hazard ratio (HR) 3.6, 95% confidence interval (CI) 1.3–10.3; P=0.015) and imaging signs of right ventricular dysfunction (HR 2.8, 95% CI 1.5–5.2; P=0.001) as independent predictors of events. In the intermediate–high risk group, patients with two cardiac biomarkers performed worse than those with one cardiac biomarker (HR 3.3, 95% CI 1.8–6.2; P=0.003). Conclusions: Risk stratification in normotensive pulmonary embolism should consider the cumulative presence of cardiac biomarkers and imaging signs of right ventricular dysfunction, especially in the intermediate–high risk subgroup.

Widening of coronary sinus in CT pulmonary angiography indicates right ventricular dysfunction in patients with acute pulmonary embolism

2010 ◽  
Vol 20 (7) ◽  
pp. 1615-1620 ◽  
Author(s):  
Grzegorz Staskiewicz ◽  
Elżbieta Czekajska-Chehab ◽  
Jerzy Przegalinski ◽  
Andrzej Tomaszewski ◽  
Kamil Torres ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Right Ventricular ◽  
Coronary Sinus ◽  
Acute Pulmonary Embolism ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Pulmonary Angiography ◽  
Ct Pulmonary Angiography
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