The prognostic value of ST-segment elevation in the lead aVR in patients with acute pulmonary embolism.
ABSTRACT Electrocardiogram (ECG) in patients with acute pulmonary embolism (APE) presents many abnormalities. There are no data concerning prognostic significance of ST-elevation (STE) in lead aVR in patients with APE. Aim: To assess the prevalence of STE in aVR in patients with APE and its correlation with clinical course as well as other ECG parameters recorded at admission.
The retrospective analysis of 293 patients with APE diagnosed according to the ESC guidelines (182 females, 111 males, mean age 65.4 ± 15.5 years).
The STE in lead aVR was observed in 133 (45.3%) patients. In comparison with patients without STE, patients with STE in lead aVR (STaVR[+]) had significantly more often systolic blood pressure 〈 90 mm Hg on admission (27% vs 10%, p 〈 0.001) and positive troponin level (64.8% vs 27.9%, p 〈 0.001). Thrombolytic therapy (14.3% vs 5.6%, p = 0.009) and catecholamines (29.3% vs 7.5%, p 〈 0.001) were more frequently used in patients with STaVR(+). The overall mortality (16.5% vs 6.9%, p = 0.009) and complication rates during hospitalisation (38.3% vs 12.5%, p 〈 0.001) were significantly higher in patients with STaVR(+). The STaVR(+) was significantly more frequent in patients with negative T-waves in inferior leads (59.4% vs 39.4%, p 〈 0.001), STE in lead III (24% vs 5.6%, p 〈 0.001), STE in lead V1 (46.6% vs 7.5%, p 〈 0.001), ST depression in lead V(4)-V(6) (48.9% vs 7.5%, p 〈 0.001), right bundle branch block (15.8% vs 8.1%, p = 0.04), QR sign in lead V1 (18% vs 6.2%, p 〈 0.001) and SI-QIII-TIII (46.6% vs 21.2%, p 〈 0.001).
The presence of STE in lead aVR in patients with APE is associated with poor prognosis. The presence of STE in lead aVR could be an easily obtainable and noninvasive ECG parameter, helpful in risk stratification of patients with APE.
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ABSTRACT: Acute pulmonary embolism (PE) is a major health problem associated with significant morbidity and mortality. Mortality of massive PE can be reduced by prompt and appropriate diagnosis and therapy. We present our observations from 3 patients of acute PE with electrocardiogram (ECG) recordings available after clinical deterioration. The characteristic ECG findings of massive PE with hemodynamic instability were ST elevation in lead aVR with concomitant ST depression in leads I and V-4 to V-6. In patients with suspected acute PE, these ECG findings may aid in the rapid identification of high- risk patients who may benefit from thrombolytic therapy or mechanical intervention.The American journal of emergency medicine 02/2013; 31(2):456.e5–456.e8. DOI:10.1016/j.ajem.2012.08.001 · 1.27 Impact Factor
- The American journal of emergency medicine 03/2013; 31(5). DOI:10.1016/j.ajem.2012.11.030 · 1.27 Impact Factor
- The American journal of emergency medicine 03/2013; 31(5). DOI:10.1016/j.ajem.2012.11.029 · 1.27 Impact Factor