Clinic of Cardiology and Urgent Internal Medicine, Military Medical Academy, Serbia.
Clinic of Cardiology, University of Nis, Serbia.
Eur Heart J Acute Cardiovasc Care. 2020 Jun;9(4):271-278. doi: 10.1177/2048872618823441. Epub 2019 Jan 11.
Electrocardiography (ECG) signs, typical or acute pulmonary embolism, and their changes can be used for the prediction of clinical and haemodynamic outcomes.
To study the predictive value of the resolution of admission ECG signs in higher risk pulmonary embolism patients for 30-day survival and for the decrease in right ventricular systolic pressure.
We analysed the 12-lead ECGs at admission and daily for the first 5 days after hospitalisation in 110 intermediate-high and high-risk pulmonary embolism patients admitted to the intensive care unit of a single tertiary centre. The predictive value of the resolution of four ECG signs were analysed for 30-day survival and for the changes in right ventricular systolic pressure during hospitalisation: S-wave in the first standard lead, right bundle branch block pattern, S-wave in the aVL lead and negative T-waves in precordial leads.
ECG recordings showed the existence of S-wave in the I lead in 71 (64.5%), S-wave in the aVL in 77 (70%), right bundle branch block pattern in 30 (27.3%) and negative T-waves in 66 (60%) patients. All-cause 30-day in-hospital mortality was 13.6%. Among the ECG signs, only the presence of right bundle branch block at admission was significantly associated with 30-day all-cause mortality (hazard ratio (HR) adjusted for age, gender and right ventricular systolic pressure at admission was 7.7, 95% confidence interval (CI) 2.1-27.9; =0.002). The resolution of three ECG signs during the first 5 days of hospitalisation, S-wave in the I lead (HR 26.4, 95% CI 3.1-226.6; =0.003), S-wave in the aVL (HR 21.5, 95% CI 2.6-175.3; =0.004) and right bundle branch block configuration (HR 5.2, 95% CI 1.3-20.8; =0.020) were associated with 30-day survival. The intermediate-high and high-risk pulmonary embolism patients with S-wave resolution in lead aVL had 0.0% and 7.1% 30-day all-cause mortality, respectively. The patients with resolution of the S-wave in the first lead and in aVL as well as right bundle branch block had more pronounced changes in right ventricular systolic pressure at discharge (27±13 vs. 13±15 mmHg; =0.011 for S-wave in I lead resolution, 27±12 vs. 15±17 mmHg; =0.004 for S-wave in aVL resolution and 23±14 vs. 9±14 mmHg; =0.040 for right bundle branch block resolution) than patients without resolution.
Resolution of S-waves and right bundle branch block in ECG correlates with lower all-cause 30-day mortality in intermediate-high and high-risk pulmonary embolism patients. Resolution of S-waves in the first lead and in aVL and right bundle branch block correlates with a decrease of right ventricular systolic pressure.
心电图（ECG）的特征，典型或急性肺栓塞，及其变化可用于预测临床和血液动力学结局。
研究入院时心电图（ECG）特征的消退在预测高危肺栓塞患者 30 天生存率和右心室收缩压下降方面的预测价值。
我们分析了 110 例中高危肺栓塞患者在入住单中心重症监护病房的前 5 天每天进行的 12 导联心电图。分析了入院时及住院第 1 至 5 天心电图 S 波在 I 导联、aVL 导联、右束支阻滞（RBBB）和胸前导联 T 波倒置消退对 30 天生存率和右心室收缩压变化的预测价值。
心电图记录显示，71 例（64.5%）患者存在 I 导联 S 波、77 例（70%）患者存在 aVL 导联 S 波、30 例（27.3%）患者存在 RBBB 及 66 例（60%）患者存在胸前导联 T 波倒置。全因 30 天院内死亡率为 13.6%。在这些心电图特征中，只有入院时存在 RBBB 与 30 天全因死亡率显著相关（校正年龄、性别和入院时右心室收缩压后，危险比（HR）为 7.7，95%置信区间（CI）为 2.1-27.9；=0.002）。入院后前 5 天 3 种心电图特征的消退，I 导联 S 波（HR 26.4，95%CI 3.1-226.6；=0.003）、aVL 导联 S 波（HR 21.5，95%CI 2.6-175.3；=0.004）和 RBBB 形态（HR 5.2，95%CI 1.3-20.8；=0.020）与 30 天生存率相关。aVL 导联 S 波消退的中高危肺栓塞患者 30 天全因死亡率分别为 0.0%和 7.1%。存在 I 导联 S 波和 aVL 导联 S 波消退以及 RBBB 的患者，出院时右心室收缩压变化更明显（27±13 vs. 13±15mmHg；I 导联 S 波消退者差异有统计学意义，27±12 vs. 15±17mmHg；=0.004；aVL 导联 S 波消退者差异有统计学意义，23±14 vs. 9±14mmHg；=0.040）。
中高危肺栓塞患者心电图 S 波和 RBBB 的消退与全因 30 天死亡率较低相关。I 导联 S 波、aVL 导联 S 波和 RBBB 的消退与右心室收缩压降低相关。
