Hariharan Praveen, Dudzinski David M, Okechukwu Ikenna, Takayesu James Kimo, Chang Yuchiao, Kabrhel Christopher
Center for Vascular Emergencies, Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Clin Cardiol. 2015 Apr;38(4):236-42. doi: 10.1002/clc.22383. Epub 2015 Apr 2.
Electrocardiographic (ECG) changes may be seen with pulmonary emboli (PE). Whether ECG is associated with short-term adverse clinical events after PE is less well established.
ECG findings are associated with short-term clinical deterioration after PE.
Consecutive adult PE patients were enrolled in an academic emergency department from 2008 to 2011. The primary outcome was right heart strain (RHS) on echocardiogram or CT pulmonary angiography, or TnT ≥0.1 ng/mL. We derived an ECG (TwiST) score that is associated with RHS and short-term adverse clinical events.
We enrolled 298 patients with PE. On multivariate analysis, T-wave inversion in leads V(1) through V(3) (OR: 4.7, 95% confidence interval [CI]: 1.7-13.2), S wave in lead I (OR: 2.0, 95% CI: 1.1-3.5), and tachycardia (OR: 2.5, 95% CI: 1.3-4.8) were associated with RHS. A TwiST score ≤2 (n = 210, 72%) was 84% (95% CI: 77%-90%) sensitive for the absence of RHS, whereas a TwiST score ≥5 (n = 47, 16%) was 93% (95% CI: 88%-97%) specific for the presence of RHS.
A simple ECG (TwiST) score can identify patients likely or not likely to have RHS with >80% specificity and sensitivity and may assist in identifying patients with acute PE at risk for adverse clinical events before pursuing other advanced imaging tests.
肺栓塞（PE）患者可能出现心电图（ECG）改变。但ECG与PE后短期不良临床事件之间的关联尚不明确。
ECG表现与PE后短期临床病情恶化相关。
2008年至2011年期间，连续纳入某学术急诊科的成年PE患者。主要结局为超声心动图或CT肺动脉造影显示的右心劳损（RHS），或肌钙蛋白T（TnT）≥0.1 ng/mL。我们得出了一个与RHS和短期不良临床事件相关的ECG（TwiST）评分。
我们纳入了298例PE患者。多因素分析显示，V（1）至V（3）导联T波倒置（比值比[OR]：4.7，95%置信区间[CI]：1.7 - 13.2）、I导联S波（OR：2.0，95% CI：1.1 - 3.5）以及心动过速（OR：2.5，95% CI：1.3 - 4.8）与RHS相关。TwiST评分≤2（n = 210，72%）对无RHS的敏感度为84%（95% CI：77% - 90%），而TwiST评分≥5（n = 47，16%）对有RHS的特异度为93%（95% CI：88% - 97%）。
一个简单的ECG（TwiST）评分能够以大于80%的特异度和敏感度识别可能有或没有RHS的患者，并且在进行其他高级影像学检查之前，可能有助于识别有急性PE且存在不良临床事件风险的患者。
