Prognostic Value of Electrocardiography in Elderly Patients with Acute Pulmonary Embolism

Bolt, Lucy; Lauber, Sandro; Limacher, Andreas; Samim, Daryoush; Löwe, Axel; Tritschler, Tobias; Baumgartner, Christine; Aujesky, Drahomir

doi:10.1016/j.amjmed.2019.05.041

Cited by 14 publications

(7 citation statements)

References 42 publications

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“…Right ventricular dysfunction is associated with thrombotic load and one of the important prognostic factors of pulmonary embolism. In APE patients, there is always at least one ECG sign of right ventricular strain, including S I Q III T III , right bundle branch block and T wave inversions 14 . Our model included a total of 6 ECG sign, and these indicators have previously been reported to be related to pulmonary embolism.…”

Section: Discussionmentioning

confidence: 99%

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Development and validation of a prediction model to estimate risk of acute pulmonary embolism in deep vein thrombosis patients

Meng

et al. 2022

Sci Rep

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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). To develop and validate a prediction model to estimate risk of APE in DVT patients combined with past medical history, clinical symptoms, physical signs, and the sign of the electrocardiogram. We analyzed data from a retrospective cohort of patients who were diagnosed as symptomatic VTE from 2013 to 2018 (n = 1582). Among them, 122 patients were excluded. All enrolled patients confirmed by pulmonary angiography or computed tomography pulmonary angiography (CTPA) and compression venous ultrasonography. Using the LASSO and logistics regression, we derived a predictive model with 16 candidate variables to predict the risk of APE and completed internal validation. 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 and syncope), five signs (skin cold clammy, tachycardia, diminished respiration, pulmonary rales and accentuation/splitting of P2), and six ECG indicators (SIQIIITIII, right axis deviation, left axis deviation, S1S2S3, T wave inversion and 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). 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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Section: Discussionmentioning

confidence: 99%

“…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 first 24 h of hospital admission were included in the study.…”

Section: Methodsmentioning

confidence: 99%

Development and validation of a prediction model to estimate risk of acute pulmonary embolism in deep vein thrombosis patients

Meng

et al. 2022

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Right ventricular dysfunction is associated with thrombotic load and one of the important prognostic factors of pulmonary embolism. In APE patients, there is always at least one ECG sign of right ventricular strain, including S Q T , right bundle branch block and T wave inversions 14 . Our model included a total of 6 ECG sign, these indicators have previously been reported to be related to pulmonary embolism.…”

Section: Discussionmentioning

confidence: 99%

“…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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“…Increased serum troponin level indicates right ventricular dysfunction. 2,3 The aim of this study is to investigate the effect of troponin values on prognosis in patients diagnosed with PTE.…”

Section: Introductionmentioning

confidence: 99%

The effect of troponin values on prognosis in acute pulmonary embolism

Ilkhan¹,

Çelikhisar

2020

Int J Clin Trials

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Background: The objective of this study is to evaluate the clinical usefulness of cardiac troponin levels in acute pulmonary thromboembolism (PTE) prognosis.Methods: Thorax computed tomography (CT) angiography was performed and reported by the radiologist as pulmonary embolism and 193 patients older than 18 years of age who were considered PTE by the physician of chest diseases were included in the study. Patients diagnosed with PTE were divided into two groups as those who died within 30 days and did not die within 30 days. As a result of the statistically significant relationship between troponin and mortality, receiver operating characteristic (ROC) analysis was performed to determine the prognosis level of troponin and appropriate sensitivity and specificity cut-off values were determined.Results: We determined that troponin levels of patients diagnosed with PTE in the emergency department were statistically significantly higher in the group with mortality (p=0.031). Since the area under the curve (AUC) value was calculated as 0.636, troponin value was found to have a weak-medium significance in terms of predicting 30-day mortality.Conclusions: Troponin values are statistically significantly higher in patients with a one-month period than the survivor group in this period. However, we concluded that troponin values are not clinically usable as mortality markers due to their low sensitivity and specificity rates. However, due to its significant relationship with increased mortality, patients with PTE with high troponin values should be hospitalized and monitored closely.

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Prognostic Value of Electrocardiography in Elderly Patients with Acute Pulmonary Embolism

Cited by 14 publications

References 42 publications

Development and validation of a prediction model to estimate risk of acute pulmonary embolism in deep vein thrombosis patients

Development and validation of a prediction model to estimate risk of acute pulmonary embolism in deep vein thrombosis patients

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

The effect of troponin values on prognosis in acute pulmonary embolism

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