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

Abstract

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.

Atrial fibrillation, venous thromboembolism, ischemic stroke, and all‐cause mortality: The Tromsø study

“…16,20 A recently published meta-analysis found AF at admission to be predictive of in-hospital death in patients with PE in unadjusted analyses. 21 To what extent AF impacts VTE mortality in the general population is unclear. In the present study, we therefore aimed to investigate the joint effect of AF and VTE on the risk of all-cause mortality.…”

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

“…Sensitivity analyses that removed Kukla et al (2014) from the pooled data did not have an impact on the associations (Kukla et al, 2014). Recent evidence has outlined the role of ECG in prognosticating PE (Digby et al, 2015;Qaddoura et al, 2017). ECG is noninvasive, available in remote areas, quick to interpret, and low cost.…”

The long‐term prognostic value of highly sensitive cardiac troponin I in patients with acute pulmonary embolism

“…Electrocardiography (ECG) tracings were interpreted by an investigator blinded to clinical and outcome data. The tabulated ECG data included rate, rhythm, axis, and ECG signs of RV strain, defined as T‐wave inversion in leads V 1 to V 3 or right bundle branch block …”

“…The tabulated ECG data included rate, rhythm, axis, and ECG signs of RV strain, defined as Twave inversion in leads V 1 to V 3 or right bundle branch block. 13 Echocardiography images were analyzed by a board-certified echocardiologist. Parameters indicative of RV dysfunction were tabulated; these were: RV dilation, RV hypokinesis, and ventricular septal wall flattening.…”