Use of ischemic ECG patterns for risk stratification in intermediate-risk patients with acute PE

Kukla, Piotr; McIntyre, William F.; Fijorek, Kamil; Krupa, Ewa; Mirek-Bryniarska, Ewa; Jastrzębski, Marek; Bryniarski, Krzysztof; Zajchowski, Wiktor; Bryniarski, Leszek; Baranchuk, Adrián

doi:10.1016/j.ajem.2014.07.029

Cited by 19 publications

(20 citation statements)

References 15 publications

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“…The following are commonalities between the findings of our groups' studies and the studies by the Kukla's group [6,7,19]. First, STDV reflects worse prognosis compared to NTW.…”

Section: Discussionmentioning

confidence: 67%

“…We identified three types of ischemic ECG patterns that are common ECG manifestations and of prognostic significance. Kukla et al [7] found that "global ischemic pattern" (presence of at least one lead with STE in leads III, aVR and V1-V4 and at least two leads with STD in I, aVL and V4-V6) similar to our LV subendocardial plus RV transmural ischemic pattern was not associated with worse outcome in intermediate-risk APE patients. However, "ST-segment ischemic pattern" (presence of at least one lead with STE in leads III, aVR and V1-V4 or at least two leads with STD in leads I, aVL and V4-V6) is associated with a worse prognosis in intermediate-risk APE patients.…”

Section: Discussionmentioning

confidence: 86%

“…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: 99%

“…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%

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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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“…The following are commonalities between the findings of our groups' studies and the studies by the Kukla's group [6,7,19]. First, STDV reflects worse prognosis compared to NTW.…”

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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“…found that several combinations of ECG findings, including “STE in lead aVR with concomitant STD in leads I and V4–V6” and “STE in leads III and/or V1/V2 with concomitant STD in leads V4–V6,” predicted development of hemodynamic instability. In 2014, Kukla et al [10]. reported that STE in at least one of leads III, aVR and V1–V4 or STD in at least two lateral leads was associated with mortality in acute PE.…”

Section: Discussionmentioning

confidence: 99%

Pulseless electrical activity in acute massive pulmonary embolism during thrombolytic therapy

Yu¹,

Jeng²

2017

Tzu Chi Med J

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We report a case of acute pulmonary embolism with hemodynamic instability diagnosed by a computed tomography pulmonary angiogram. The patient developed pulseless electrical activity during systemic thrombolytic therapy with recombinant tissue plasminogen activator. Successful return of spontaneous circulation was achieved after immediate cardiopulmonary resuscitation with chest compressions for 6 min. His electrocardiogram (ECG) on arrival in the emergency department displayed sinus tachycardia, an S wave in lead I, a Q wave in lead III, incomplete right bundle branch block (RBBB), T-wave inversion (TWI) in leads V1–V3, ST elevation in leads aVR and V1, and ST depression in leads I, II, III, aVF, and V4–V6. These characteristic ECG changes might have prognostic value for clinical deterioration. He recovered after treatment. After discharge, the ECG showed resolution of TWI in leads V1–V3 and incomplete RBBB, suggesting recovery from right ventricular dysfunction, which was confirmed by an echocardiogram on follow in the outpatient department.

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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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Use of ischemic ECG patterns for risk stratification in intermediate-risk patients with acute PE

Cited by 19 publications

References 15 publications

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

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

Pulseless electrical activity in acute massive pulmonary embolism during thrombolytic therapy

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

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