肺栓塞中不同心电图模式与休克指数、右心室收缩压和直径以及栓塞负荷评分的关联

Association of different electrocardiographic patterns with shock index, right ventricle systolic pressure and diameter, and embolic burden score in pulmonary embolism.

作者信息

Krća Bojana, Džudović Boris, Vukotić Snježana, Ratković Nenad, Subotić Bojana, Vraneš Danijela, Rusović Siniša, Obradović Slobodan

出版信息

Vojnosanit Pregl. 2016 Oct;73(10):921-6. doi: 10.2298/VSP150512011K.

DOI:10.2298/VSP150512011K

PMID:29327898

Abstract

BACKGROUND/AIM: Some electrocardiographic (ECG) patterns are characteristic for pulmonary embolism but exact meaning of the different ECG signs are not well known. The aim of this study was to determine the association between four common ECG signs in pulmonary embolism [complete or incomplete right bundle branch block (RBBB), S-waves in the aVL lead, S1Q3T3 sign and negative T-waves in the precordial leads] with shock index (SI), right ventricle diastolic diameter (RVDD) and peak systolic pressure (RVSP) and embolic burden score (EBS).

METHODS

The presence of complete or incomplete RBBB, S waves in aVL lead, S1Q3T3 sign and negative T-waves in the precordial leads were determined at admission ECG in 130 consecutive patients admitted to the intensive care unit of a single tertiary medical center in a 5-year period. Echocardiography examination with measurement of RVDD and RVSP, multidetector computed tomography pulmonary angiography (MDCT-PA) with the calculation of EBS and SI was determined during the admission process. Multivariable regression models were calculated with ECG parameters as independent variables and the mentioned ultrasound, MDCT-PA parameters and SI as dependent variables.

RESULTS

The presence of S-waves in the aVL was the only independent predictor of RVDD (F = 39.430, p < 0.001; adjusted R2 = 0.231) and systolic peak right ventricle pressure (F = 29.903, p < 0.001; adjusted R2 = 0.185). Negative T-waves in precordial leads were the only independent predictor for EBS (F = 24.177, p < 0.001; R2 = 0.160). Complete or incomplete RBBB was the independent predictor of SI (F = 20.980, p < 0.001; adjusted R2 = 0.134).

CONCLUSION

In patients with pulmonary embolism different ECG patterns at admission correlate with different clinical, ultrasound and MDCT-PA parameters. RBBB is associated with shock, Swave in the aVL is associated with right ventricle pressure and negative T-waves with the thrombus burden in the pulmonary tree.

摘要

背景/目的：一些心电图（ECG）模式是肺栓塞的特征性表现，但不同ECG征象的确切意义尚不清楚。本研究的目的是确定肺栓塞中四种常见ECG征象[完全或不完全右束支传导阻滞（RBBB）、aVL导联S波、S1Q3T3征和胸前导联T波倒置]与休克指数（SI）、右心室舒张直径（RVDD）、收缩压峰值（RVSP）和栓塞负荷评分（EBS）之间的关联。

方法

在一家三级医疗中心的重症监护病房连续收治的130例患者入院时的心电图上，确定是否存在完全或不完全RBBB、aVL导联S波、S1Q3T3征和胸前导联T波倒置。在入院过程中进行超声心动图检查以测量RVDD和RVSP，进行多排螺旋CT肺动脉造影（MDCT-PA）以计算EBS和SI。以ECG参数作为自变量，上述超声、MDCT-PA参数和SI作为因变量，计算多变量回归模型。

结果

aVL导联出现S波是RVDD（F = 39.430，p < 0.001；调整后R2 = 0.231）和右心室收缩压峰值（F = 29.903，p < 0.001；调整后R2 = 0.185）的唯一独立预测因素。胸前导联T波倒置是EBS的唯一独立预测因素（F = 24.177，p < 0.001；R2 = 0.16）。完全或不完全RBBB是SI的独立预测因素（F = 20.980，p < 0.001；调整后R2 = 0.134）。