2015
DOI: 10.1111/acem.12769
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Findings From 12‐lead Electrocardiography That Predict Circulatory Shock From Pulmonary Embolism: Systematic Review and Meta‐analysis

Abstract: Objectives Treatment guidelines for acute pulmonary embolism (PE) recommend risk-stratifying patients to assess PE severity, as those at higher risk should be considered for therapy in addition to standard anticoagulation to prevent right ventricular (RV) failure, which can cause hemodynamic collapse. The hypothesis was that 12-lead electrocardiography (ECG) can aid in this determination. The objective of this study was to measure the prognostic value of specific ECG findings (the Daniel score, which includes … Show more

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Cited by 123 publications
(100 citation statements)
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“…A recent meta‐analysis about the prognostic value of various ECG findings in patients with acute PTE, identifies heart rates > 100 bpm and the presence of S1Q3T3 pattern, complete RBBB, T wave inversion in leads V 1 through V 4 , atrial fibrillation, and STE aVR , as six electrocardiographic findings that predict the development of hemodynamic collapse or hospital death. Among these factors, T wave inversion in leads V 2 and V 3 , and STE aVR with respective odds ratios of 6.94, 7.07, and 5.24 have had the highest impact on poor hospital outcome . However, the studies that are included in this meta‐analysis, except for the study by Janata et al, focus on STE aVR in the context of other electrocardiographic findings.…”
Section: Discussionmentioning
confidence: 99%
“…A recent meta‐analysis about the prognostic value of various ECG findings in patients with acute PTE, identifies heart rates > 100 bpm and the presence of S1Q3T3 pattern, complete RBBB, T wave inversion in leads V 1 through V 4 , atrial fibrillation, and STE aVR , as six electrocardiographic findings that predict the development of hemodynamic collapse or hospital death. Among these factors, T wave inversion in leads V 2 and V 3 , and STE aVR with respective odds ratios of 6.94, 7.07, and 5.24 have had the highest impact on poor hospital outcome . However, the studies that are included in this meta‐analysis, except for the study by Janata et al, focus on STE aVR in the context of other electrocardiographic findings.…”
Section: Discussionmentioning
confidence: 99%
“…Shopp et al recently performed a meta-analysis of 10 studies of ECG in acute PE, involving 3007 patients. Six ECG parameters were associated with poorer 30-day outcome: heart rate >100 beats/min, S1Q3T3, complete RBBB, inverted T waves in V1–V4, ST elevation in aVR and atrial fibrillation 41 . The Daniel score (a 21-point scoring system) was significantly lower in those patients without 30-day haemodynamic collapse (mean 2.6±1.5 cf.…”
Section: Imaging Laboratory and Other Clinical Investigations For Rimentioning
confidence: 98%
“…Other scoring systems, for example, HASBLED, have been largely developed and validated in AF cohorts. In a retrospective study of 223 patients with PE and 314 with DVT who were commenced on VKA between 2006 and 2007 in three hospitals in the Netherlands, the HASBLED score was used to estimate the risk of major bleeding within 180 days 41 . Cumulative incidences of major bleeds were 1.3% (95% CI 0.1 to 2.5) in the non-high risk group (HASBLED <3) and 9.6% (95% CI 2.2 to 17.0) in the high-risk group (HASBLED ≥3) (p<0.0001 by log-rank test), with an HR of 8.7 (95% CI 2.7 to 28.4).…”
Section: Assessment Of Bleeding Riskmentioning
confidence: 99%
“…They found the TwiST score to have a slightly higher sensitivity and specificity than the Daniel score for predicting an adverse clinical outcome 3. A recent meta-analysis by Shopp et al reviewed the use of 12lead ECG to predict circulatory shock in patients with PE 44. However, they only used ECG findings on the Daniel score (namely, tachycardia, RBBB, TWI in V 1 through V 4 , S1Q3T3), in addition to STE-aVR and AF 44.…”
mentioning
confidence: 99%