Department of Pulmonary Diseases, Suleyman Demirel University Faculty of Medicine, Isparta, Turkey.
Clin Appl Thromb Hemost. 2011 Apr;17(2):188-96. doi: 10.1177/1076029609351877. Epub 2009 Dec 2.
Objective diagnosis of severe pulmonary embolism (PE) is obligatory because of its considerable mortality.
To assess the abilities of electrocardiography (ECG) score (sECG) and the newly generated scoring system composed of the scores obtained from arterial blood gas (ABG) analysis and shock index (SI) in addition to sECG in predicting severe PE.
The degree of pulmonary vascular obstruction (sPVO) and the right ventricular dysfunction (RVD) were determined with spiral computed tomography (CT) in 53 consequent patients with PE. Twelve-lead ECG taken within a day of PE event and ABG values were evaluated according to ECG scoring system and original Geneva system, respectively.
The mean age of patients was 62.6 ± 13.4 years. Right ventricular dysfunction, sPVO ≥ 50%, hypoxemia, and SI were present in 34 (64.2%), 27 (50.9%), 50 (94.3%), and 22 (41.5%) patients, respectively. The mean sECG, 5.9 ± 5.1, was correlated with sPVO, maximum diameter of right ventricle (RV), and right ventricle to left ventricle (RV/LV) ratio (r = .385, r = .415, and r = .329, respectively). The mean newly generated score was 10.9 ± 5.5 and correlated with sPVO, maximum diameter of RV, and RV/LV ratio (r = .394, r = .483, and r = .393, respectively). Receiver operator characteristic (ROC) curve analyses revealed that sECG ≥ 3.5, s (ECG + SI) ≥ 4.5, and s (ECG + SI + ABG) ≥ 9.5 predict the severe PE patients with 70.6%, 61.8%, 58.8% sensitivities and 52.6%, 63.2%, 73.7% specificities, respectively.
Adding the scores obtained from SI and ABG to the sECG enhances the specificity of sECG in predicting RVD (+) or severe PE patients, although a lesser degree decreasing in sensitivity may occur.
由于严重肺栓塞（PE）死亡率较高，因此必须进行客观诊断。
评估心电图（ECG）评分（sECG）和新生成的评分系统的能力，该评分系统由动脉血气（ABG）分析和休克指数（SI）的评分以及 sECG 组成，用于预测严重 PE。
对 53 例连续的 PE 患者进行螺旋 CT（CT）确定肺血管阻塞程度（sPVO）和右心室功能障碍（RVD）。在 PE 事件发生后的一天内评估 12 导联心电图，并根据 ECG 评分系统和原始日内瓦系统评估 ABG 值。
患者的平均年龄为 62.6 ± 13.4 岁。34 例（64.2％）存在右心室功能障碍、sPVO≥50％、低氧血症和 SI，27 例（50.9％）、50 例（94.3％）和 22 例（41.5％）分别存在。平均 sECG 为 5.9 ± 5.1，与 sPVO、右心室最大直径（RV）和右心室与左心室（RV/LV）比值相关（r =.385，r =.415，r =.329）。平均新生成的评分是 10.9 ± 5.5，与 sPVO、RV 最大直径和 RV/LV 比值相关（r =.394，r =.483，r =.393）。接收器操作特性（ROC）曲线分析表明，sECG≥3.5、s（ECG+SI）≥4.5 和 s（ECG+SI+ABG）≥9.5 预测严重 PE 患者的敏感性分别为 70.6％、61.8％和 58.8％，特异性分别为 52.6％、63.2％和 73.7％。
将 SI 和 ABG 的评分添加到 sECG 中可以提高 sECG 预测 RVD（+）或严重 PE 患者的特异性，尽管敏感性会略有降低。
