The role of ST-segment elevation in lead aVR in the risk assessment of patients with acute pulmonary embolism

Janata, Karin; Höchtl, Thomas; Wenzel, Catharina; Járai, Rudolf; Fellner, Barbara; Geppert, Alexander; Smetana, Peter; Havranek, Vera; Huber, Kurt

doi:10.1007/s00392-011-0395-z

Cited by 21 publications

(39 citation statements)

References 44 publications

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

Section: Resultsmentioning

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.…”

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confidence: 99%

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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

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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.

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“…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: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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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

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“…However, the literature suggests that the distribution of STDV has consistent regularity and mechanisms [6][7][8][9][13][14][15][16]. STE in leads V1, III, aVR and STD in leads I and V4/ V5-V6 are frequently observed in APE [6,7,9].…”

Section: Discussionmentioning

confidence: 98%

“…ST-segment deviation (STDV) (elevation and/ /or depression) is another common ECG manifestation of APE [6][7][8]. STDV could occur in 3 specific ischemic patterns: (i) left ventricular (LV) subendocardial ischemic pattern; (ii) RV transmural ischemic pattern; and (iii) LV subendocardial plus RV transmural ischemic pattern [9].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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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)

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Reciprocal Changes and Emergent Trips to the Catheterization Laboratory

2023

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The role of ST-segment elevation in lead aVR in the risk assessment of patients with acute pulmonary embolism

Abstract: ST-elevation in lead aVR is associated with a more severe course of APE, especially in patients with intermediate-risk. Therefore, aVR-ST-elevation might be useful in risk stratification of APE.

Cited by 21 publications

References 44 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

Reciprocal Changes and Emergent Trips to the Catheterization Laboratory

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