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Electrocardiographic abnormalities in patients with acute pulmonary embolism complicated by cardiogenic shock.
Am J Emerg Med. 2014 Feb 3;
Authors: Kukla P, McIntyre WF, Fijorek K, Mirek-Bryniarska E, Bryniarski L, Krupa E, Jastrzębski M, Bryniarski KL, Zhong-Qun Z, Baranchuk A
Abstract
BACKGROUND: Cardiogenic shock (CS) is a predictor of poor prognosis in patients with acute pulmonary embolism (APE).
OBJECTIVES: The aim of this study was to compare electrocardiography (ECG) parameters in patients with APE presenting with or without CS.
METHODS: A 12-lead ECG was recorded on admission at a paper speed of 25 mm/s and 10 mm/mV amplification. All ECGs were examined by a single cardiologist who was blinded to all other clinical data. All ECG measurements were made manually.
RESULTS: Electrocardiographic data from 500 patients with APE were analyzed, including 92 patients with CS. The following ECG parameters were associated with CS: S1Q3T3 sign, (odds ratio [OR]: 2.85, P < .001), qR or QR morphology of QRS in lead V1, (OR: 3.63, P < .001), right bundle branch block (RBBB) (OR: 2.46, P = .004), QRS fragmentation in lead V1 (OR: 2.94, P = .002), low QRS voltage (OR: 3.21, P < .001), negative T waves in leads V2 to V4 (OR: 1.81, P = .011), ST-segment depression in leads V4 to V6 (OR: 3.28, P < .001), ST-segment elevation in lead III (OR: 4.2, P < .001), ST-segment elevation in lead V1 (OR: 6.78, P < .01), and ST-segment elevation in lead aVR (OR: 4.35, P < .01). The multivariate analysis showed that low QRS voltage, RBBB, and ST-segment elevation in lead V1 remained statistically significant predictors of CS.
CONCLUSIONS: \In patients with APE, low QRS voltage, RBBB, and ST-segment elevation in lead V1 were associated with CS.
PMID: 24602894 [PubMed - as supplied by publisher]