非高危肺栓塞患者定量心电图参数的预后意义。

Prognostic significance of quantitative electrocardiographic parameters in patients with non-high-risk pulmonary embolism.

机构信息

State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road Xicheng District, Beijing 100037, China.

出版信息

Eur J Intern Med. 2024 Feb;120:46-51. doi: 10.1016/j.ejim.2023.08.028. Epub 2023 Sep 9.

DOI:10.1016/j.ejim.2023.08.028

PMID:37679281

Abstract

BACKGROUND

Electrocardiogram (ECG) abnormalities indicating right ventricular strain have been reported to have prognostic value in severe cases of acute pulmonary embolism (PE). We aimed to analyze the prognostic significance of other quantitative ECG parameters in non-high-risk acute PE.

METHODS

Consecutive patients with non-high-risk acute PE were prospectively enrolled. The following baseline ECG parameters were collected: rhythm, heart rate, QRS axis, right bundle branch block (RBBB) pattern, S1Q3T3 pattern, T-wave inversion, ST-segment elevation, Qr in lead V1, PR Interval, QRS complex duration, QT interval, P-wave amplitude and duration, R- and S-wave amplitudes. The primary endpoint was early discharge within three days. Associations between ECG parameters and early discharge were analyzed.

RESULTS

Overall, 383 patients were enrolled (median age: 67 years, 57% female): 277 (72.3%) with low-risk and 106 (27.7%) with intermediate-risk. The two groups of patients differed in several ECG signs of right ventricular strain and many other quantitative parameters like R- and S-wave amplitudes. In the multivariate logistic regression analysis, the S-wave depth in lead V5 (S-V5) was the only independent prognostic factor for early discharge (odds ratio = 0.137, 95% confidence interval = 0.031-0.613, p = 0.009). The optimum cutoff value of S-V5 for predicting early discharge derived from the receiver operative characteristic curve was 0.15 mv (c-statistic = 0.66, p =0.003).

CONCLUSIONS

Several ECG signs of right ventricular strain and many other quantitative parameters were associated with disease severity in non-high-risk acute PE. An S-V5 lesser than 0.15 mv was predictive for early discharge in these patients.

摘要

背景

心电图（ECG）异常提示右心室应变已被报道在严重急性肺栓塞（PE）病例中具有预后价值。我们旨在分析其他定量 ECG 参数在非高危急性 PE 中的预后意义。

方法

前瞻性连续纳入非高危急性 PE 患者。收集以下基线 ECG 参数：节律、心率、QRS 轴、右束支传导阻滞（RBBB）模式、S1Q3T3 模式、T 波倒置、ST 段抬高、V1 导联 Qr 波、PR 间期、QRS 波群持续时间、QT 间期、P 波振幅和持续时间、R 波和 S 波振幅。主要终点是三天内早期出院。分析 ECG 参数与早期出院之间的关系。

结果

共纳入 383 例患者（中位年龄：67 岁，57%为女性）：低危患者 277 例（72.3%），中危患者 106 例（27.7%）。两组患者在右心室应变的几个心电图征象和许多其他定量参数如 R 波和 S 波振幅方面存在差异。在多变量逻辑回归分析中，V5 导联 S 波深度（S-V5）是早期出院的唯一独立预测因素（优势比=0.137，95%置信区间=0.031-0.613，p=0.009）。来自受试者工作特征曲线的 S-V5 预测早期出院的最佳截断值为 0.15 mv（c 统计量=0.66，p=0.003）。