Diagnostic value of QRS and S wave variation in patients with suspicion of acute pulmonary embolism

Çağdaş, Metin; Karakoyun, Süleyman; Rencüzoğulları, İbrahim; Karabağ, Yavuz; Artaç, İnanç; İliş, Doğan; Hamideyin, Şerif; Karayol, Sibel; Çiftçi, Handan; Çınar, Tufan

doi:10.1016/j.ajem.2018.03.074

Cited by 8 publications

(11 citation statements)

References 15 publications

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“…Insignificant prevalence of both ECG signs in PE and non-PE groups are mainly due to unfiltered patients with past cardiorespiratory diseases history in the groups; therefore, they account for the possible heterogeneity of ECG evidences in both groups. 1–3…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…Variations of studies conducting research in evaluating sensitivity and specificity values of both patterns have not come to definite conclusion. 2,3 Therefore, this review aims to evaluate the diagnostic value of T-wave inversions in anterior leads difference compared to that of McGinn-White sign in patients with suspected acute PE.…”

Section: Introductionmentioning

confidence: 99%

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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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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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Section: Discussionmentioning

confidence: 99%

“…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%

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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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“…Based on literature and research reports, we screened more than 10 kinds of electrocardiogram sign associated with APE [11][12][13][14][15] . The ECGs obtained within the rst 24 hours of hospital admission were included in the study.…”

Section: Predictor Variablesmentioning

confidence: 99%

Development and Validation of Prediction Model to Estimate Risk of Acute Pulmonary Embolism: Retrospective Cohort Study

Meng

et al. 2021

Preprint

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Background: Venous thromboembolism (VTE), clinically presenting as deep vein thrombosis (DVT) or pulmonary embolism (PE). Not all DVT patients carry the same risk of developing acute pulmonary embolism (APE).Methods: Patients who were diagnosed as symptomatic VTE between June 2013 and June 2018 (n=1582) at the First Affiliated Hospital of Xi’an Jiaotong University were enrolled in this study, of whom 783 had the DVT and APE confirmed by angiography or computed tomography pulmonary angiography (CTPA). Using the LASSO and logistics regression, we derived predictive model with 16 candidate variables to predict the risk of APE and completed internal validation.Results: Overall, 52.9% patients had DVT+APE (773 vs 1460), 47.1% patients only had DVT (687 vs 1460). The APE risk prediction model included one pre-existing disease or condition (respiratory failure), one risk factors(infection), three symptoms (dyspnea, hemoptysis, syncope), five signs (skin cold clammy, tachycardia, diminished respiration, pulmonary rales, accentuation/splitting of P2, tricuspid murmur), and six ECG indicators (SⅠQⅢTⅢ, right axis deviation, left axis deviation, S1S2S3, T wave inversion, Q/q wave), of which all were positively associated with APE. The ROC curves of the model showed AUC of 0.79 (95% CI, 0.77-0.82) and 0.80 (95% CI, 0.76-0.84) in the training set and testing set. The model showed good predictive accuracy (calibration slope, 0.83 and Brier score, 0.18).Conclusion: Based on a retrospective single-center population study, we developed a novel prediction model to identify patients with different risks for APE in DVT patients, which may be useful for quickly estimating the probability of APE before obtaining definitive test results and speeding up emergency management processes.

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“…These ECG features indicate an acute right ventricular strain pattern. 1 This combined with the patient’s refractory hypoxemia strongly suggested acute pulmonary embolism (APE). An emergency bedside transthoracic echocardiogram was performed and showed right ventricular (RV) enlargement and a flattened interventricular septum.…”

Section: Response To Ecg Challengementioning

confidence: 99%

A Patient With Acute Shortness of Breath and Inferior ST-Segment Elevation: A Diagnostic Trap

Ding

Shi³

2021

Circulation

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Diagnostic value of QRS and S wave variation in patients with suspicion of acute pulmonary embolism

Cited by 8 publications

References 15 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

Development and Validation of Prediction Model to Estimate Risk of Acute Pulmonary Embolism: Retrospective Cohort Study

A Patient With Acute Shortness of Breath and Inferior ST-Segment Elevation: A Diagnostic Trap

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