The Value of Electrocardiographic Abnormalities in the Prognosis of Pulmonary Embolism: A Consensus Paper

Digby, Geneviève C.; Kukla, Piotr; Zhong-qun, Zhan; Pastore, Carlos Alberto; Piotrowicz, Ryszard; Schapachnik, Edgardo; Zaręba, Wojciech; Luna, Antonio; Pruszczyk, Piotr; Baranchuk, Adrián

doi:10.1111/anec.12278

Cited by 59 publications

(45 citation statements)

References 70 publications

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“…When more than one ECG was present we selected the highest quality ECG that was most closely related in time to its respective CTPA. AM scored each ECG for the presence or absence of eight features that have been reported to occur more commonly in PE9 (table 1) without knowledge of the CTPA result.…”

Section: Methodsmentioning

confidence: 99%

ECG in suspected pulmonary embolism

Thomson

Kourounis

Trenear

et al. 2019

Postgraduate Medical Journal

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ObjectiveTo establish the diagnostic value of prespecified ECG changes in suspected pulmonary embolism (PE).MethodsRetrospective case–control study in a district general hospital setting. We identified 189 consecutive patients with suspected PE whose CT pulmonary angiogram (CTPA) was positive for a first PE and for whom an ECG taken at the time of presentation was available. We matched these for age±3 years with 189 controls with suspected PE whose CTPA was negative. We considered those with large (n=76) and small (n=113) clot load separately. We scored each ECG for the presence or absence of eight features that have been reported to occur more commonly in PE.Results20%–25% of patients with PE, including those with large clot load, had normal ECGs. The most common ECG abnormality in patients with PE was sinus tachycardia (28%). S1Q3T3 (3.7%), P pulmonale (0.5%) and right axis deviation (4.2%) were infrequent findings. Right bundle branch block (9.0%), atrial dysrhythmias (10.1%) and clockwise rotation (20.1%) occurred more frequently but were also common in controls. Right ventricular (RV) strain pattern was significantly more commonly in patients than controls, 11.1% vs 2.6% (sensitivity 11.1%, specificity 97.4%; OR 4.58, 95% CI 1.63 to 15.91; p=0.002), particularly in those with large clot load, 17.1% vs 2.6% (sensitivity 17.1%, specificity 97.4%; OR 7.55, 95% CI 1.62 to 71.58; p=0.005).ConclusionAn ECG showing RV strain in a breathless patient is highly suggestive of PE. Many of the other ECG changes that have been described in PE occur too infrequently to be of predictive value.

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Section: Methodsmentioning

confidence: 99%

ECG in suspected pulmonary embolism

Thomson

Kourounis

Trenear

et al. 2019

Postgraduate Medical Journal

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“…() from the pooled data did not have an impact on the associations (Kukla et al., ). Recent evidence has outlined the role of ECG in prognosticating PE (Digby et al., ; Qaddoura et al., ). ECG is noninvasive, available in remote areas, quick to interpret, and low cost.…”

Section: Discussionmentioning

confidence: 99%

Use of fragmented QRS in prognosticating clinical deterioration and mortality in pulmonary embolism: A meta‐analysis

Qaddoura

Digby

Kabali

et al. 2018

Noninvasive Electrocardiol

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“…This is associated with higher clot load in acute pulmonary embolism (APE)1 and with higher mortality and greater risk of clinical deterioration 2. Acute coronary syndrome (ACS) can also cause T wave inversion (TWI), but in ACS with TWI in leads V1–V4 it would be unusual to find TWI in leads III and aVF as well 3.…”

Section: Discussionmentioning

confidence: 99%