Department of Emergency Medicine, Atrium Health's Carolinas Medical Center (Carolinas Medical Center is the Central Site of the Pulmonary Embolism Short-term Outcomes Registry (PESCOR) consortium), Charlotte, North Carolina, USA.
Jaron D. Raper, Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Acad Emerg Med. 2022 Oct;29(10):1185-1196. doi: 10.1111/acem.14554. Epub 2022 Jul 20.
We sought to determine associations of early electrocardiogram (ECG) patterns with clinical deterioration (CD) within 5 days and with RV abnormality (abnlRV) by echocardiography in pulmonary embolism (PE).
In this prospective, multicenter study of newly confirmed PE patients, early echocardiography and initial ECG were examined. Initial ECG patterns included lead-specific ST-segment elevation (STE) or depression (STD), T-wave inversion (TWI), supraventricular tachycardia (SVT), sinus tachycardia, and right bundle branch block as complete (cRBBB) or incomplete (iRBBB). We defined CD as respiratory failure, hypotension, dysrhythmia, cardiac arrest, escalated PE intervention, or death within 5 days. We calculated odds ratios (ORs) for CD and abnlRV with univariate and full multivariate models in the presence of other variables.
Of 1676 patients, 1629 (97.2%) had both ECG and GDE; 415/1676 (24.7%) had CD, and 529/1629 (32.4%) had abnlRV. AbnlRV had an OR for CD of 4.25 (3.35, 5.38). By univariable analysis, the absence of abnormal ECG patterns had OR for CD and abnlRV of 0.34 (0.26, 0.44; p < 0.001) and 0.24 (0.18, 0.31; p < 0.001), respectively. By multivariable analyses, one ECG pattern had a significant OR for CD: SVT 2.87 (1.66, 5.00). Significant ORS for abnlRV were: TWI V 4.0 (2.64, 6.12), iRBBB 2.63 (1.59, 4.38), STE aVR 2.42 (1.58, 3.74), S1-Q3-T3 2.42 (1.70, 3.47), and sinus tachycardia 1.68 (1.14, 2.49).
SVT was an independent predictor of CD. TWI V , iRBBB, STE aVR, sinus tachycardia, and S1-Q3-T3 were independent predictors of abnlRV. Finding one or more of these ECG patterns may increase considerations for performance of echocardiography to look for RV abnormalities and, if present, inform concerns for early clinical deterioration.
我们旨在确定肺栓塞（PE）患者早期心电图（ECG）模式与 5 天内临床恶化（CD）以及超声心动图异常右心室（abnlRV）的相关性。
在这项新确诊 PE 患者的前瞻性、多中心研究中，我们检查了早期超声心动图和初始 ECG。初始 ECG 模式包括导联特异性 ST 段抬高（STE）或压低（STD）、T 波倒置（TWI）、室上性心动过速（SVT）、窦性心动过速和完全性（cRBBB）或不完全性（iRBBB）右束支传导阻滞。我们将 5 天内出现呼吸衰竭、低血压、心律失常、心脏骤停、PE 介入升级或死亡定义为 CD。在存在其他变量的情况下，我们使用单变量和全多变量模型计算 CD 和 abnlRV 的比值比（OR）。
在 1676 例患者中，1629 例（97.2%）同时进行了 ECG 和 GDE 检查；415/1676（24.7%）例发生 CD，529/1629（32.4%）例出现 abnlRV。abnlRV 发生 CD 的 OR 为 4.25（3.35，5.38）。单变量分析显示，异常 ECG 模式缺失发生 CD 和 abnlRV 的 OR 分别为 0.34（0.26，0.44；p<0.001）和 0.24（0.18，0.31；p<0.001）。多变量分析显示，一种 ECG 模式与 CD 显著相关：SVT 的 OR 为 2.87（1.66，5.00）。与 abnlRV 显著相关的 ORS 为：V 导联 TWI 的 OR 为 4.0（2.64，6.12），iRBBB 的 OR 为 2.63（1.59，4.38），STE aVR 的 OR 为 2.42（1.58，3.74），S1-Q3-T3 的 OR 为 2.42（1.70，3.47），窦性心动过速的 OR 为 1.68（1.14，2.49）。
SVT 是 CD 的独立预测因子。V 导联 TWI、iRBBB、STE aVR、窦性心动过速和 S1-Q3-T3 是 abnlRV 的独立预测因子。如果存在一种或多种这些 ECG 模式，可能需要考虑进行超声心动图检查以寻找 RV 异常，如果存在，则提示需要早期临床恶化。
