To evaluate the role of electrocardiogram (ECG) for detection right ventricular dysfunction in patients with acute pulmonary embolism.
Ninety-five consecutive patients with acute pulmonary embolism who had transthoracic echocardiogram performed within 24 to 48 hours of clinical presentation were included in study. Exclusion criteria were chronic obstructive pulmonary disease, cor-pulmonale, primary pulmonary hypertension, dilated cardiomyopathy, and class III or IV heart failure.
Fourteen patients were excluded from the study. The remaining 81 patients comprised study population (age 65±15years, 56% females, 46% blacks). By transthoracic echocardiography, right ventricular dysfunction was found in 40 patients (49%). The 12-lead ECGs recorded on admission or during first 24 hours of presentation were analyzed for T wave inversion in anterior precordial leads V1 to V3, right bundle branch block, S wave in lead-I with Q wave in lead-III, and sinus tachycardia. Inverted T wave in the anterior precordial leads had a sensitivity of 68% and specificity of 88% for detection of right ventricular dysfunction with positive and negative predictive values of 84% and 73%, respectively. The right bundle branch block had sensitivity of 23% and specificity of 88%, S wave in lead-I with Q wave in lead-III had sensitivity of 27% and specificity of 95%, and sinus tachycardia had sensitivity of 58% and specificity of 68% for detection of right ventricular dysfunction. The predictive values of these findings are given in Table
ECG findings for detection of right ventricular dysfunction in acute pulmonary embolismECG FindingSensitivitySpecificityPositive Predictive ValueNegative Predictive ValueT wave inversion in leads V1 to V368%88%84%73%Right bundle branch block23%88%64%54%S in lead-I with Q in lead-III27%95%85%57%Sinus tachycardia58%68%64%62%. Only 3 patients (8%) with right ventricular dysfunction had normal ECG, whereas 20 patients (49%) without right ventricular dysfunction had normal ECG.CONCLUSIONS: Inverted T wave in anterior precordial leads has the highest sensitivity and S wave in lead-I with Q wave in lead-III has the highest specificity for identifying patients with right ventricular dysfunction in acute pulmonary embolism at admission or during first 24 hours of presentation.
Electrocardiographic changes can be surrogate markers to identify patients with right ventricular dysfunction in acute pulmonary embolism and, therefore, can facilitate important urgent therapeutic considerations.
G. Punukollu, None.