Prognostic Value of Electrocardiography in Elderly Patients with Acute Pulmonary Embolism.
- Bolt L Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland. Electronic address: lucy.bolt@insel.ch.
- Lauber S Department of Internal Medicine, Spital Thun, Thun, Switzerland.
- Limacher A Clinical Trials Unit (CTU) Bern, University of Bern, Switzerland.
- Samim D Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
- Löwe A Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
- Tritschler T Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Division of Hematology, Department of Medicine, University of Ottawa, Ontario, Canada.
- Baumgartner C Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
- Aujesky D Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
- 2019-06-28
Published in:
- The American journal of medicine. - 2019
Electrocardiography
Prognostic value
Pulmonary embolism
Right ventricular strain
Acute Disease
Aged
Aged, 80 and over
Bundle-Branch Block
Cohort Studies
Electrocardiography
Female
Follow-Up Studies
Geriatric Assessment
Hospital Mortality
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Observer Variation
Prognosis
Prospective Studies
Pulmonary Embolism
Survival Analysis
Ventricular Dysfunction, Right
English
BACKGROUND
Electrocardiographic (ECG) signs of right ventricular strain could be used as a simple tool to risk-stratify patients with acute pulmonary embolism.
METHODS
We studied consecutive patients aged ≥65 years with acute pulmonary embolism in a prospective multicenter cohort study. Two readers independently analyzed 12 predefined ECG signs of right ventricular strain in all patients. The outcome was the occurrence of an adverse clinical event, defined as death from any cause within 90 days or a complicated in-hospital course. We determined the interrater reliability for each ECG sign and examined the association between right ventricular strain signs and adverse events using logistic regression, adjusting for the Pulmonary Embolism Severity Index and cardiac troponin.
RESULTS
Overall, 320/390 patients (82%) showed at least one ECG sign of right ventricular strain. The interrater reliability for individual ECG signs was highly variable (ᴋ 0.40-0.95). Patients with ≥1 of the 3 classic signs of right ventricular strain (S1Q3T3, right bundle branch block, or T wave inversions in V1-V4) had a higher incidence of adverse events than those without (13% vs 6%; P = .026). After adjustment, the presence of ≥1 of the 3 classic signs of right ventricular strain (odds ratio 2.11; 95% confidence interval, 1.00-4.46) and the number of right ventricular strain signs present were significantly associated with adverse events (odds ratio 1.35 per sign; 95% confidence interval, 1.08-1.69).
CONCLUSIONS
ECG signs of right ventricular strain are common in elderly patients with acute pulmonary embolism. Although such signs may have prognostic value, their variable reliability and the rather modest prognostic effect size may limit their usefulness in the risk stratification of pulmonary embolism.
Electrocardiographic (ECG) signs of right ventricular strain could be used as a simple tool to risk-stratify patients with acute pulmonary embolism.
METHODS
We studied consecutive patients aged ≥65 years with acute pulmonary embolism in a prospective multicenter cohort study. Two readers independently analyzed 12 predefined ECG signs of right ventricular strain in all patients. The outcome was the occurrence of an adverse clinical event, defined as death from any cause within 90 days or a complicated in-hospital course. We determined the interrater reliability for each ECG sign and examined the association between right ventricular strain signs and adverse events using logistic regression, adjusting for the Pulmonary Embolism Severity Index and cardiac troponin.
RESULTS
Overall, 320/390 patients (82%) showed at least one ECG sign of right ventricular strain. The interrater reliability for individual ECG signs was highly variable (ᴋ 0.40-0.95). Patients with ≥1 of the 3 classic signs of right ventricular strain (S1Q3T3, right bundle branch block, or T wave inversions in V1-V4) had a higher incidence of adverse events than those without (13% vs 6%; P = .026). After adjustment, the presence of ≥1 of the 3 classic signs of right ventricular strain (odds ratio 2.11; 95% confidence interval, 1.00-4.46) and the number of right ventricular strain signs present were significantly associated with adverse events (odds ratio 1.35 per sign; 95% confidence interval, 1.08-1.69).
CONCLUSIONS
ECG signs of right ventricular strain are common in elderly patients with acute pulmonary embolism. Although such signs may have prognostic value, their variable reliability and the rather modest prognostic effect size may limit their usefulness in the risk stratification of pulmonary embolism.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.amjmed.2019.05.041
- PMID 31247179
- Persistent URL
- https://sonar.ch/global/documents/185144
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