Predictors of inhospital prognosis in acute pulmonary embolism

Agrawal, Neetu; Ramegowda, Raghu Thagachagere; Patra, Soumya; Hegde, Madhav; Agarwal, Ashish; Kolhari, Vikram B; Gupta, Kamal; Nanjappa, Manjunath Cholenahally

doi:10.1097/mbc.0000000000000093

Cited by 24 publications

(25 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Twenty studies (4898 patients) reported data on in‐hospital mortality . Several ECG features were meta‐analyzed for this outcome (Table ).…”

Section: Resultsmentioning

confidence: 99%

“…Twenty studies (4898 patients) reported data on in-hospital mortality. [4][5][6][7]9,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26] Several ECG features were meta-analyzed for this outcome ( Table 2). Figure 2 shows 4 sample forest plots for the association between in-hospital mortality and each of the following ECG findings: S1Q3T3, any RBBB, TWI in precordial leads, and TWI in precordial or inferior leads.…”

Section: In-hospital Mortalitymentioning

confidence: 99%

“…Since the publication of the Daniel score, several other studies have investigated the use of ECG as a tool for PE prognostication. These studies expanded the use of ECG and included findings not included in the Daniel score, such as ST‐segment depression, ST‐segment elevation (STE), Qr in lead V 1 , right axis deviation (RAD), and P pulmonale, among others . A recent consensus article by the International Society of Electrocardiology, the International Society for Holter and Noninvasive Electrocardiology, and the Iberoamerican Forum of Arrhythmias in the Internet demonstrated the need for a formal and comprehensive evaluation of the evidence for the use of ECG to prognosticate PE …”

Section: Introductionmentioning

confidence: 99%

“…These studies expanded the use of ECG and included findings not included in the Daniel score, such as ST-segment depression, ST-segment elevation (STE), Qr in lead V 1 , right axis deviation (RAD), and P pulmonale, among others. [5][6][7][8][9][10] A recent consensus article by the International Society of Electrocardiology, the International Society for Holter and Noninvasive Electrocardiology, and the Iberoamerican Forum of Arrhythmias in the Internet demonstrated the need for a formal and comprehensive evaluation of the evidence for the use of ECG to prognosticate PE. 11 We aimed to comprehensively evaluate the data on ECG as a tool to prognosticate PE by performing a systematic review and meta-analysis of the available evidence.…”

mentioning

confidence: 99%

See 3 more Smart Citations

The value of electrocardiography in prognosticating clinical deterioration and mortality in acute pulmonary embolism: A systematic review and meta‐analysis

Qaddoura

Digby

Kabali

et al. 2017

Clinical Cardiology

View full text Add to dashboard Cite

The role of electrocardiography (ECG) in prognosticating pulmonary embolism (PE) is increasingly recognized. ECG is quickly interpretable, noninvasive, inexpensive, and available in remote areas.We hypothesized that ECG can provide useful information about PE prognostication. We searched MEDLINE, EMBASE, Google Scholar, Web of Science, abstracts, conference proceedings, and reference lists through February 2017. Eligible studies used ECG to prognosticate for the main outcomes of death and clinical deterioration or escalation of therapy. Two authors independently selected studies; disagreement was resolved by consensus. Ad hoc piloted forms were used to extract data and assess risk of bias. We used a random-effects model to pool relevant data in meta-analysis with odds ratios (ORs) and 95% confidence intervals (CIs); all other data were synthesized qualitatively. Statistical heterogeneity was assessed using the I 2 value. We included 39 studies (9198 patients) in the systematic review. There was agreement in study selection (κ:0.91, 95% CI: 0.86-0.96). Most studies were retrospective; some did not appropriately control for confounders. ECG signs that were good predictors of a negative outcome included S1Q3T3 (OR:3.38, 95% CI: 2.46-4.66, P < 0.001), complete right bundle branch block (OR: 3.90, 95% CI: 2.46-6.20, P < 0.001), T-wave inversion (OR: 1.62, 95% CI: 1.19-2.21, P = 0.002), right axis deviation (OR: 3.24, 95% CI: 1.86-5.64, P < 0.001), and atrial fibrillation (OR: 1.96, 95% CI: 1.45-2.67, P < 0.001) for in-hospital mortality. Several ischemic patterns also were significantly predictive.Our conclusion is that ECG is potentially valuable in prognostication of acute PE.

show abstract

“…Twenty studies (4898 patients) reported data on in‐hospital mortality . Several ECG features were meta‐analyzed for this outcome (Table ).…”

Section: Resultsmentioning

confidence: 99%

Section: In-hospital Mortalitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

The value of electrocardiography in prognosticating clinical deterioration and mortality in acute pulmonary embolism: A systematic review and meta‐analysis

Qaddoura

Digby

Kabali

et al. 2017

Clinical Cardiology

View full text Add to dashboard Cite

show abstract

“…STDV is considered a common, but non--specific, ECG manifestation in patients with APE by some authors [11,12]. However, the literature suggests that the distribution of STDV has consistent regularity and mechanisms [6][7][8][9][13][14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Significance of ST-segment deviation in patients with acute pulmonary embolism and negative T waves

et al. 2015

View full text Add to dashboard Cite

Background: Common electrocardiogram (ECG) manifestations in acute pulmonary embolism (APE) include ST-segment deviation (STDV) along with negative T-waves (NTW). STDV could occur in 3 typical ischemic patterns: (i) the left ventricular (LV) subendocardial ischemic pattern; (ii) the right ventricular (RV) transmural ischemic pattern; and (iii) the LV intensification of therapy, and death compared to patients without STDV (p = 0.001 for each variable). The majority (89%) of the patients with STDV presented with 1 of the 3 typical ischemic ECG patterns. LV subendocardial ischemic pattern (OR = 4.963, p = 0.004), RV transmural ischemic pattern (OR = 3.128, p = 0.021) and LV subendocardial plus RV transmural ischemic pattern (OR = 3.036, p = 0.017) independently predicted the need to intensify therapy. RV transmural ischemic pattern (OR = 4.227, p = 0.031) and LV subendocardial plus RV transmural ischemic pattern (OR = 4.022, p = 0.032) (Cardiol J 2015; 22, 5: 583-589)

show abstract

Investigating the effects of systemic thrombolysis on electrocardiography and pulmonary artery blood pressure in patients with pulmonary embolism

Dastani,

Askari,

Nasimi Shad

et al. 2024

Health Science Reports

View full text Add to dashboard Cite

Background and AimsWe aimed to evaluate the association between electrocardiography (ECG) and echocardiographic findings in patients with pulmonary embolism (PE) before and after systemic thrombolysis.MethodsWe included 38 PE patients admitted to the hospital with approved right ventricular (RV) dysfunction who were indicated for systemic thrombolysis. Indications for systemic thrombolysis were considered as patients who were either hemodynamically unstable on admission or became unstable in the course of hospital admission. Systemic thrombolysis was performed by either Reteplase or Alteplase. ECG and echocardiographic findings were documented at baseline and 12–24 h following systemic thrombolysis.ResultsOur results showed that TAPSE significantly increased while RV size and pulmonary artery systolic pressure (PAP) notably decreased after systemic thrombolysis (p < 0.001). The ECG abnormalities markedly diminished after systemic thrombolysis in PE patients (p < 0.001). Additionally, 100% of our patients had more than one ECG abnormality at baseline, while 55.3% had no ECG abnormalities after systemic thrombolysis. Further, the median number of ECG abnormalities remarkably attenuated after systemic thrombolysis (from 2.0 (1.0) to 0.0 (1.0), p < 0.001). Our results also revealed that delta RV size (r = 0.51, p = 0.001) and delta TAPSE (r = 0.4, p = 0.012) were positively correlated while mortality (r = −0.55, p = 0.001) was negatively associated with changes in the number of ECG abnormalities before and after systemic thrombolysis.ConclusionWe showed that systemic thrombolysis improved echocardiographic and electrocardiographic findings in PE patients. Additionally, a greater decreased number of ECG abnormalities after systemic thrombolysis was accompanied by more improvement in RV size and TAPSE and a lower mortality rate.

show abstract

Predictors of inhospital prognosis in acute pulmonary embolism

Cited by 24 publications

References 27 publications

The value of electrocardiography in prognosticating clinical deterioration and mortality in acute pulmonary embolism: A systematic review and meta‐analysis

The value of electrocardiography in prognosticating clinical deterioration and mortality in acute pulmonary embolism: A systematic review and meta‐analysis

Significance of ST-segment deviation in patients with acute pulmonary embolism and negative T waves

Investigating the effects of systemic thrombolysis on electrocardiography and pulmonary artery blood pressure in patients with pulmonary embolism

Contact Info

Product

Resources

About