Characteristics of synthesized right-sided chest electrocardiograms in patients with acute pulmonary embolism.
J Cardiol. 2018 Dec 26;:
Authors: Kusayama T, Furusho H, Kinoshita M, Kaneko S, Usuda K, Takamura M
BACKGROUND: The significance of right-sided chest lead electrocardiogram (ECG) abnormalities in acute pulmonary embolism (APE) is unclear. This study evaluated the characteristics of such abnormalities in APE patients.
METHODS: This retrospective study included consecutive patients who were diagnosed with APE by contrast-enhanced computed tomography or pulmonary artery angiography. A standard 12-lead ECG and a synthesized right-sided chest ECG were obtained from these patients. Waveform differences were noted between the acute and post-treatment phases.
RESULTS: In total, 56 APE patients (18 men and 38 women, mean age 66.7±13.3 years) were included. Traditional ECG findings, such as right-axis deviation, the S1Q3T3 pattern, and clockwise rotation, were found in relatively few patients (14.3%, 32.1%, and 21.4%, respectively). In some cases, a negative T wave in standard 12-lead ECGs was observed in leads III, V1, and V2 (46.4%, 60.7%, and 39.9%, respectively). Syn-V3R ECG showed a higher frequency of negative T waves (66.1%) at the onset and significantly (p<0.01) decreased at the follow-up. Multiple logistic regression analyses for differentiating APE revealed that the negative T waves only in lead syn-V3R were significantly related (odds ratio: 6.95, 95% confidence interval: 2.50-19.32, p<0.001).
CONCLUSIONS: The presence of a negative T wave in a synthesized right-sided chest ECG, particularly in the V3R lead, is a new and distinctive finding denoting pulmonary embolism. To confirm the utility of this characteristic using synthesized right-sided chest ECGs for the diagnosis of APE, further studies with larger populations will be required.
PMID: 30594338 [PubMed - as supplied by publisher]