The Value of Different Electrocardiographic Patterns at Hospital Admission in Predicting Clinical Outcome in Pulmonary Embolism

Abstract

Background: Literature reports the presence of several Electrocardiographic (ECG) patterns of Right Ventricular (RV) strain in acute Pulmonary Embolism (PE). These reports are inconsistent considering the prognostic value of these patterns. Aim: to evaluate the significance of ECG RV strain patterns, as well as the total number of these ECG patterns in predicting short-term (in-hospital) clinical outcome. Methods: This retrospective study was consisted of 183 patients (107 male, age: 61±14 years) with acute PE. The 12-lead ECG done at hospital admission was analysed. ECG RV strain was diagnosed in presence of one or more of following 12 patterns: tachycardia, atrial fibrillation, low QRS voltage, S1Q3T3, Q in III, aVF, right axis deviation, right bundle branch block, Qr in V1, negative T wave in inferior, precordial leads, ST elevation in inferior leads, aVR, V1 and ST depression. The outcome was defined as experience of an adverse event (in-hospital complications and death all-cause). The association of ECG patterns with outcome was evaluated by multivariable Cox hazards regression analysis. Results: During a median hospitalization time of 15 days, 41 (22.4%) adverse events occurred. Event rate was higher in patients with ≥5 ECG patterns than in <5 (63.4% vs. 0.7%; p<0.0001). Number of ECG RV strain patterns (Hazard Ratio (HR):1.7 per pattern; 95% Confidence Interval (CI): 1.1-2.6; p=0.009), ST elevation in inferior leads (HR: 8.4; 95% CI: 6.0-68.3; p=0.001) and ST depression (HR: 0.1; 95% CI: 0.03-0.6; p=0.01) were independently associated with adverse outcome. Conclusion: Number of ECG RV strain patterns, ST elevation in inferior leads, ST depression has independent value in predicting in-hospital adverse outcome in acute PE. Keywords: Acute pulmonary embolism; Electrocardiographic right ventricular strain pattern; Number of electrocardiographic right ventricular strain pattern; Ischemic patterns