A novel ECG parameter for diagnosis of acute pulmonary embolism: RS time

Introduction: Acute pulmonary embolism is the leading cause of cardiovascular mortality in which only 7% of total suspected cases were correctly diagnosed. Prompt diagnosis is essential to reduce disease burden. 12-lead electrocardiography has become standard of examination in any acute cardiovascular setting. Several abnormalities associated with right ventricular dysfunction include the classic McGinn-White and anterior leads T-wave inversion pattern due to conduction abnormalities. Nevertheless, studies conducting research in evaluating diagnostic values of both patterns have not come to definite conclusion. This review evaluates the diagnostic value of T-wave inversions in anterior leads difference compared to that of McGinn-White sign in patients with suspected acute pulmonary embolism. Methods: Literature searching was conducted from medical databases. Inclusion-exclusion criteria and study eligibility were assessed to select the included studies in this systematic review. Three final articles were selected and critically appraised using the Oxford Center of Evidence-Based Medicine appraisal tools for diagnostic study. Results: Considering the compared importance of selected studies, T-wave inversion shows better specificity (90.9% vs 88.7%) and sensitivity (35.5% vs 28.9%) although both signs exhibit minor impact in terms of sensitivity index. Analyses suggest higher averaged accuracy (accuracy index) and Youden index found in T-wave inversion than that of McGinn-White sign (accuracy index: 57.97% vs 56.16%; Youden index: 0.16 vs 0.12), providing more meaningful diagnostic value. Furthermore, anterior leads T-wave inversion possesses better diagnostic odds ratio than that of McGinn-White sign (5.52 vs 3.17). Conclusion: Anterior lead T-wave inversions present better diagnostic value than that of classic pattern of McGinn-White sign in electrocardiographic presentation of suspected acute pulmonary embolism.

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“…Rencuzogullari et al 1 Cagdas et al 2 Park et al 3 studies exhibit less important effect toward the conclusion of the diagnostic result.…”

Section: Appraisal Criteriamentioning

confidence: 99%

Diagnostic comparison of anterior leads T-wave inversion and McGinn-White sign in suspected acute pulmonary embolism: A systematic review and meta-analysis

Laurentius

Ariani

2020

Hong Kong Journal of Emergency Medicine

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“…The prolonged RS time has been suggested to be related to the right ventricular dilation, pulmonary artery hypertension, and right ventricular dysfunction and proposed to be due to the lateness in electrical conduction and the alteration in the orientation of the QRS vector at the termination of depolarization 9,26 . The elongation of RS time duration has been demonstrated to be a predictor of pulmonary embolism 9 . Moreover, it is found to be related to short-term mortality after pulmonary embolism 26 .…”

Section: Discussionmentioning

confidence: 99%

“…The inferolateral leads signified by leads D1, AVL, D2, D3, AVF, V4, V5, and V6 were used to measure RS time. The longest duration evaluated from these leads was received as the RS time 9 .…”

Section: Ecg Evaluationmentioning

confidence: 99%

“…It has been previously reported that wide and slurred S-waves in leads I, II, III, V4, V5, and V6 can be encountered in pulmonary heart diseases 8 . Moreover, right ventricular overload may appear on the ECG by stretching the S-wave and widening the duration from the beginning of QRS to the nadir of S-wave (RS time) in the inferolateral leads 9 . RS time, the prolongation of which is recommended to be used to detect acute pulmonary embolism, is a newly introduced ECG parameter 9 .…”

Section: Introductionmentioning

confidence: 99%

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Relationship between RS time and the severity of chronic obstructive pulmonary disease

Yıldız

Yildiz

Sazlidere

et al. 2021

Cukurova Medical Journal

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ÖzPurpose: The aim of our study was to determine whether the RS time measured on an electrocardiogram is associated with the severity of chronic obstructive pulmonary disease (COPD). Materials and Methods: The study population was made up of 100 COPD patients with a mean age of 63 ± 10 years (86% were males). These patients were divided into the mild and moderate COPD (GOLD 1-2) group (n = 45) and the severe and very severe COPD (GOLD 3-4) group (n = 55) according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages. These groups were compared with each other. Results: Heart rate, P wave axis, QRS axis, RS time, and incidence of right bundle branch block were significantly higher in patients with severe and very severe COPD. In the multivariable analysis, heart rate, P wave axis, and RS time (odds ratio = 1.081) were the independent predictors of severe and very severe COPD. The receiver operating characteristic curve analysis showed that the best RS time cutoff value for the prediction of severe and very severe COPD was 60 ms, with a sensitivity of 69.1% and a specificity of 66.7%. Conclusion: RS time simply measured on an electrocardiogram may be a useful screening test for the quick estimation of patients with severe and very severe COPD. Amaç: Çalışmamızın amacı, elektrokardiyogramdan ölçülen RS zamanının kronik obstrüktif akciğer hastalığı (KOAH) şiddeti ile ilişkili olup olmadığını belirlemekti. Gereç ve Yöntem: Çalışma popülasyonu, ortalama yaşı 63 ± 10 yıl olan (% 86 erkekti) 100 KOAH hastasından oluştu. Kronik Obstrüktif Akciğer Hastalığına Karşı Küresel Girişim (GOLD) aşamalarına göre bu hastalar hafif ve orta derecede KOAH (GOLD 1-2) grubu (s = 45) ve şiddetli ve çok şiddetli KOAH (GOLD 3-4) grubuna (s = 55) ayrıldı. Bu gruplar birbirleriyle karşılaştırıldı. Bulgular: Şiddetli ve çok şiddetli KOAH'lı hastalarda kalp hızı, P dalga aksı, QRS ekseni, RS zamanı ve sağ dal bloğu insidansı anlamlı olarak daha yüksekti. Çok değişkenli analizde, kalp hızı, P dalga aksı ve RS zamanı (olasılık oranı = 1.081) şiddetli ve çok şiddetli KOAH'ın bağımsız belirleyicileriydi. Alıcı işletim karakteristik eğrisi analizi, şiddetli ve çok şiddetli KOAH tahmini için en iyi RS zaman kesme değerinin, % 69,1 duyarlılık ve % 66,7 özgüllük ile 60 ms olduğunu gösterdi. Sonuç: Bir elektrokardiyogramda basitçe ölçülen RS zamanı, şiddetli ve çok şiddetli KOAH'lı hastaların hızlı tahmini için yararlı bir tarama testi olabilir.

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“…В недавно опубликованной работе I. Rencuzogullari с соавт. было показано, что увеличение интервала RS (от начала R до пика S) более 64 мс с высокой точностью позволяет диагностировать ТЭЛА [34].…”

Section: обзоры §unclassified

T-wave inversion in the precordial leads: сardiac and non-cardiac causes

Tsoy¹,

Kolos²

2020

Kardiologiia

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The T-wave inversion (TWI) is a common electrocardiographic finding. Causes for TWI are numerous and sometimes TWI may appear in life-threatening conditions. The aim of this review was to provide an up-to-date analysis of TWI, including i) definition and prevalence; ii) causes, and iii) differential diagnosis in benign TWI, reversible myocardial ischemia of the left ventricular anterior wall; takotsubo cardiomyopathy; subarachnoid hemorrhage; pulmonary embolism; right ventricular arrhythmogenic cardiomyopathy; and “cardiac memory”. The review presents practical electrophysiological criteria, which allow suspecting in time a life-threatening condition to choose an up-to-date treatment.

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A novel ECG parameter for diagnosis of acute pulmonary embolism: RS time

Cited by 16 publications

References 26 publications

Diagnostic comparison of anterior leads T-wave inversion and McGinn-White sign in suspected acute pulmonary embolism: A systematic review and meta-analysis

Diagnostic comparison of anterior leads T-wave inversion and McGinn-White sign in suspected acute pulmonary embolism: A systematic review and meta-analysis

Relationship between RS time and the severity of chronic obstructive pulmonary disease

T-wave inversion in the precordial leads: сardiac and non-cardiac causes

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