Background: Massive pulmonary embolism (PE) that causes
severe pulmonary hypertension can produce specific ECG abnormalities.
We hypothesized that an ECG scoring system would vary in proportion to
the severity of pulmonary hypertension and would help to distinguish
patients with massive PE from patients with smaller PE and those
Methods: A 21-point ECG scoring system was
derived (relative weights in parentheses): sinus tachycardia (2),
incomplete right bundle branch block (2), complete right bundle branch
block (3), T-wave inversion in leads V1 through
V4 (0 to 12), S wave in lead I (0), Q wave in lead III (1),
inverted T in lead III (1), and entire
S1Q3T3 complex (2). ECGs obtained
within 48 h prior to pulmonary arteriography were located for 60
patients (26 positive for PE, 34 negative for PE) and for 25 patients
with fatal PE.
Results: Interobserver agreement (11
readers) for ECG score was good (Spearman r = 0.74).
The ECG score showed significant positive relationship to systolic
pulmonary arterial pressure (sPAP) in patients with PE
(r = 0.387, p < 0.001), whereas no significant
relationship was seen in patients without PE
(r = − 0.08, p = 0.122). When patients were
grouped by severity of pulmonary hypertension (low, moderate, severe),
only patients with severe pulmonary hypertension from PE had a
significantly higher ECG score (mean, 5.8 ± 4.9). At a cutoff of 10
points, the ECG score was 23.5% (95% confidence interval [CI], 16
to 31%) sensitive and 97.7% (95% CI, 96 to 99%) specific for the
recognition of severe pulmonary hypertension (sPAP > 50 mm Hg)
secondary to PE. In 25 patients with fatal PE, the ECG score was
9.5 ± 5.2.
Conclusions: The derived ECG score
increases with severity of pulmonary hypertension from PE, and a score≥
10 is highly suggestive of severe pulmonary hypertension from