Electrocardiographic findings associated with early clinical deterioration in acute pulmonary embolism.

Autor: Weekes AJ; 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., Raper JD; 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., Thomas AM; 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.; Alyssa M. Thomas, Emergency Department, Houston Methodist Baytown Hospital, Houston, Texas, USA., Lupez K; 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.; Kathryn Lupez, Department of Emergency Medicine, Tufts Medical Center, Boston, Massachusetts, USA., Cox CA; 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.; Carly A. Cox, Emergency Medicine of Idaho, Meridian, Idaho, USA., Esener D; Department of Emergency Medicine Kaiser Permanente, San Diego, California, USA., Boyd JS; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Nomura JT; Department of Emergency Medicine, Christiana Care, Newark, Delaware, USA., Davison J; Department of Emergency Medicine, Orlando Health, Orlando, Florida, USA., Ockerse PM; Division of Emergency Medicine, University of Utah Health, Salt Lake City, Utah, USA., Leech S; Department of Emergency Medicine, Orlando Health, Orlando, Florida, USA., Abrams E; Department of Emergency Medicine Kaiser Permanente, San Diego, California, USA., Kelly C; Division of Emergency Medicine, University of Utah Health, Salt Lake City, Utah, USA., O'Connell NS; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
Jazyk: angličtina
Zdroj: Academic emergency medicine : official journal of the Society for Academic Emergency Medicine [Acad Emerg Med] 2022 Oct; Vol. 29 (10), pp. 1185-1196. Date of Electronic Publication: 2022 Jul 20.
DOI: 10.1111/acem.14554
Abstrakt: Objectives: 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).
Methods: 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.
Results: 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 2-4 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).
Conclusions: SVT was an independent predictor of CD. TWI V 2-4 , 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.
(© 2022 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)
Databáze: MEDLINE
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