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ABSTRACT: The initial clinical presentation and echocardiography have key roles in risk stratification of patients with acute pulmonary embolism (PE). To assess the value of shock index and echocardiographic abnormalities as predictors of in-hospital complications and mortality, echocardiographic features of 159 patients diagnosed with acute PE were reviewed. A shock index > or =1, independent of echocardiographic findings, was associated with increased in-hospital mortality. Regardless of shock index, moderate to severe right ventricular (RV) hypokinesis and a ratio of RV to left ventricular (LV) end-diastolic diameter >1 was significantly associated with in-hospital mortality and demonstrated the best predictive values for short-term outcomes. The sensitivity and negative predictive value of diastolic LV impairment (E/A wave <1), RV hypokinesis, RV/LV >1, and end-diastolic RV diameter >3 cm for in-hospital mortality were 100%. Systolic pulmonary artery pressure (PAP) was higher in patients who died before discharge. A cut-off point >50 mm Hg for systolic PAP was significantly associated with increased in-hospital death. In conclusion, among conventional echocardiographic abnormalities attributed to RV dysfunction (E/A wave <1, RV hypokinesis, RV/LV >1, RV end-diastolic diameter >3 cm, and interventricular septal flattening), moderate to severe RV hypokinesis and RV/LV >1 have better predictive values for short-term outcomes of patients with acute PE. In addition, a shock index > or =1 and systolic PAP >50 mm Hg could also be helpful in the triage of these patients.
The American Journal of Cardiology 03/2008; 101(5):700-5. · 3.37 Impact Factor
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ABSTRACT: Risk stratification of patients with a diagnosis of acute pulmonary embolism (PE) is crucial in deciding appropriate management. An electrocardiographic (ECG) scoring system may potentially be useful in identifying patients at high risk of increased hospital morbidity and mortality from acute PE. Electrocardiography and echocardiography of 159 patients with a diagnosis of acute PE using ventilation/perfusion scan or spiral computed tomographic scan at 2 Emory-affiliated hospitals were reviewed. The 21-ECG score was compared with the presence or absence of right ventricular (RV) dysfunction and the 2 major end points of complicated in-hospital course or death. ECG score was significantly higher in patients with RV dysfunction (p <0.001) and a complicated in-hospital course (p <0.05). Although the ECG score was higher in nonsurvivors, it was not significantly different. Based on receiver-operator characteristic curves, an ECG score > or =3 could predict RV dysfunction with sensitivity, specificity, and positive and negative predictive values of 76%, 82%, 76%, and 86%, respectively. An ECG score > or =3 could predict a complicated in-hospital course and mortality with sensitivities of 58% and 59%, specificities of 60% and 58%, positive predictive values of 16% and 10%, and negative predictive values of 89% and 95%, respectively. In conclusion, the current 21-ECG scoring system can predict RV dysfunction in patients with acute PE well. However; its ability to predict an adverse in-hospital course is limited. Nevertheless, an ECG score <3 predicts better short-term outcome in these patients.
The American Journal of Cardiology 11/2007; 100(7):1172-6. · 3.37 Impact Factor
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ABSTRACT: Precise recording of the standard 12-lead electrocardiogram (ECG) is technically time consuming. Placing limb leads on the torso has the major advantages of ease of use, increased speed of application, and decreased artifact. This modified ECG frequently substitutes for the standard 12-lead ECG in intensive care units to detect ischemia, although its implementation should be limited to interpreting arrhythmias. We describe a patient who was misdiagnosed with acute inferior myocardial infarction in a modified 12-lead ECG. To the best of our knowledge, this is the first case report regarding detection of false ST elevations in this setting. Always, a standard 12-lead ECG is recommended to evaluate any ST-T changes.
Journal of electrocardiology 41(3):197-201. · 1.08 Impact Factor
