Prognostic Value of Electrocardiography in Elderly Patients with Acute Pulmonary Embolism - 12/12/19
, Sandro Lauber, MD b, Andreas Limacher, PhD c, Daryoush Samim, MD d, Axel Löwe, MD a, Tobias Tritschler, MD a, e, Christine Baumgartner, MD, MAS a, Drahomir Aujesky, MD, MSc aAbstract |
Background |
Electrocardiographic (ECG) signs of right ventricular strain could be used as a simple tool to risk-stratify patients with acute pulmonary embolism.
Methods |
We studied consecutive patients aged ≥65 years with acute pulmonary embolism in a prospective multicenter cohort study. Two readers independently analyzed 12 predefined ECG signs of right ventricular strain in all patients. The outcome was the occurrence of an adverse clinical event, defined as death from any cause within 90 days or a complicated in-hospital course. We determined the interrater reliability for each ECG sign and examined the association between right ventricular strain signs and adverse events using logistic regression, adjusting for the Pulmonary Embolism Severity Index and cardiac troponin.
Results |
Overall, 320/390 patients (82%) showed at least one ECG sign of right ventricular strain. The interrater reliability for individual ECG signs was highly variable (ᴋ 0.40-0.95). Patients with ≥1 of the 3 classic signs of right ventricular strain (S1Q3T3, right bundle branch block, or T wave inversions in V1-V4) had a higher incidence of adverse events than those without (13% vs 6%; P = .026). After adjustment, the presence of ≥1 of the 3 classic signs of right ventricular strain (odds ratio 2.11; 95% confidence interval, 1.00-4.46) and the number of right ventricular strain signs present were significantly associated with adverse events (odds ratio 1.35 per sign; 95% confidence interval, 1.08-1.69).
Conclusions |
ECG signs of right ventricular strain are common in elderly patients with acute pulmonary embolism. Although such signs may have prognostic value, their variable reliability and the rather modest prognostic effect size may limit their usefulness in the risk stratification of pulmonary embolism.
Le texte complet de cet article est disponible en PDF.Keywords : Electrocardiography, Prognostic value, Pulmonary embolism, Right ventricular strain
Plan
| Funding: This research project was supported by a grant from the Swiss National Science Foundation (grant no. 33CSCO-122659/139470). The sponsor had no role in the design and conduct of the study, in the collection, analysis, interpretation of the data, in the writing process, or in the decision to submit the article for publication. TT holds an Early Postdoc. Mobility Award from the Swiss National Science Foundation (SNSF P2ZHP3 177999). |
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| Conflict of Interest: The authors declare that they have no conflicts of interest. |
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| Authorship: All authors participated in the research and preparation of the manuscript. |
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| DA; Data acquisition: DA; Data analysis and interpretation: LB, SL, DS, AL, TT, CB, DA; Drafting the manuscript: LB, CB, DA; Critical revision of the manuscript: LB, SL, AL, DS, AL, TT, CB, DA; Statistical analyses: AL; Study supervision: DA. |
Vol 132 - N° 12
P. e835-e843 - décembre 2019 Retour au numéro
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