This study aimed to investigate the diagnostic value of QRS and S wave variation in patients admitted to the emergency department with suspicion of acute pulmonary embolism (APE).

Computerized tomographic pulmonary angiography (CTPA) was performed in 118 consecutive patients to evaluate patients with suspected APE, and 106 subjects with appropriate electrocardiogram and CT images constituted the study population.

Using CTPA, APE was diagnosed in 48.1% (n:51) of the study population. The comparison of patients with APE and those without APE revealed that increased heart rate, right axis deviation of QRS axis, complete or incomplete right bundle branch block, prominent S wave in lead D1, increased QRS duration, percentage of QRS (9,8[4,8–19,0] vs 3,8[2,7–71]; p<0,001), S wave variation (22,3[9,6–31,9] vs 4,8 [2Cohen A.T., Agnelli G., Anderson F.A., Arcelus J.I., Bergqvist D., Brecht J.G., e al. Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality Thromb Haemost 2007 ;  98 (4) : 756-764Available from:. 17938798

Cliccare qui per andare alla sezione Riferimenti, 3Task A., Members F., Konstantinides S.V., Germany C., France N.D., Uk D.F., e al. ESC Guidelines on the diagnosis and management of acute pulmonary embolism Eur Heart J 2014 ;  35 (43) : 3033-3073Available from:. ehu283

Cliccare qui per andare alla sezione Riferimenti, 4Sinha N., Yalamanchili K., Sukhija R., Aronow W.S., Fleisher A.G., Lehrman S.G. Role of the 12-Lead Electrocardiogram in Diagnosing13  :  (2005). 46-49(1).

Cliccare qui per andare alla sezione Riferimenti, 5Sreeram N., Cheriex E.C., Smeets J.L., Gorgels A.P., Wellens H.J. Value of the 12-lead electrocardiogram at hospital admission in the diagnosis of pulmonary embolism Am J Cardiol 1994 ;  73 (4) : 298-303Available from:. 8296763 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 6Das M.K., Maskoun W., Shen C., Michael M.A., Suradi H., Desai M., e al. Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy Hear Rhythm 2010 ;  7 (1) : 74-80Available from:. S1547527109010844 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 7Stein P.D., Fowler S.E., Goodman L.R., Gottschalk A., Hales C.A., Hull R.D., e al. Multidetector computed tomography for acute pulmonary embolism N Engl J Med 2006 ;  354 (22) : 2317-2327Available from:. NEJMoa052367 [cross-ref]

Cliccare qui per andare alla sezione Riferimenti, 8Bova C., Greco F., Misuraca G., Serafini O., Crocco F., Greco A., e al. Diagnostic utility of echocardiography in patients with suspected pulmonary embolism Am J Emerg Med 2003 ;  21 (3) : 180-183Available from:. S0735675702422577 [inter-ref]

Cliccare qui per andare alla sezione Riferimenti]; p<0,001) and ΔS wave amplitude (1.1[0.5–1.5] vs 0.2[0.1–0.5]; p<0.001) were significantly associated with APE, but no relationship was detected with respect to the presence of atrial arrhythmias, clockwise rotation of the horizontal axis, fragmentation, ST segment deviation, T wave inversion, and S1Q3T3 and S1S2S3 patterns. The percentage of S wave variation (OR: 1072 per 1% increase, 95% CI:1011–1137) was found to be an independent predictor of APE. ΔS wave amplitude>0.5mm predicted APE with a sensitivity of 72.6% and a specificity of 74.6% (AUC:0.805, 95% CI: 0.717–0.876; p<0.001).

The present study demonstrated that QRS and S wave variation could be useful electrocardiographic signs for the diagnosis of APE.