Clinical research studyPrognostic Value of ECG Among Patients with Acute Pulmonary Embolism and Normal Blood Pressure
Section snippets
Setting and Selection of Participants
Consecutive adult patients who presented from January 1998 to June 2006 to the emergency department of a third-level teaching hospital (Careggi, Florence, Italy) with the clinical suspicion of pulmonary embolism were considered for the study. Exclusion criteria were systolic arterial pressure persistently less than 100 mm Hg, a prior documented episode of pulmonary embolism, and a history of severe chronic obstructive pulmonary disease or echocardiographic signs of long-term right ventricular
Patients and Management
A total of 557 consecutive patients with an objectively confirmed acute pulmonary embolism were considered for the study from January 1998 to June 2006. Of these patients, 36 were excluded because of shock on admission (7%), whereas 123 additional patients (22%) were excluded because they had a documented previous episode of pulmonary embolism (50 patients), were affected by severe chronic obstructive pulmonary disease, had echocardiographic signs of long-standing right ventricular overload (63
Discussion
The present study demonstrates the association of right ventricular strain pattern showed by the presentation ECG with adverse short-term outcome (clinical deterioration or death) in patients with acute pulmonary embolism and normal blood pressure. In addition, right ventricular strain was found to add incremental prognostic value to echocardiographic evidence of right ventricular dysfunction.
A large body of evidence has shown that although ECG may reveal several abnormalities in pulmonary
Conclusions
The present study of normotensive patients with pulmonary embolism revealed that right ventricular strain pattern at ECG is associated with short-term clinical deterioration and death. When combined with echocardiography, right ventricular strain was better able to recognize normotensive patients at high risk of clinical deterioration. These patients might benefit by strict surveillance during hospital stay and careful evaluation for pulmonary reperfusion therapy.
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2019, American Journal of MedicineCitation Excerpt :Right ventricular dysfunction is associated with an increased clot burden6 and is a significant prognostic factor in pulmonary embolism.7–9 The presence of several of these ECG signs has been related to an increase in short-term mortality and clinical deterioration among patients with pulmonary embolism in prospective2,3,10–13 and retrospective studies.4,14 As such, ECG might serve as an easily available prognostic tool to help guide management of patients with acute pulmonary embolism.
Funding: None.
Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.
Authorship: All authors had access to the data and played a role in writing this manuscript.