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Usefulness of different electrocardiographic patterns as predictors of in-hospital mortality in acute pulmonary embolism.

Session Novel imaging and risk stratification of acute pulmonary embolism

Speaker Pamela Alarcon

Congress : ESC Congress 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Pulmonary Embolism
  • Session type : Moderated Posters
  • FP Number : P5016

Authors : P Alarcon (Buenos Aires,AR), JA Bilbao (Buenos Aires,AR), R Melchiori (Buenos Aires,AR), IM Cigalini (Buenos Aires,AR), CE Scatularo (Buenos Aires,AR), JC Jauregui (Buenos Aires,AR), MI Bernal (Buenos Aires,AR), JM Aboy (Buenos Aires,AR), J Ortego (Buenos Aires,AR), P Schmidt (Buenos Aires,AR), AV Figueroa (Buenos Aires,AR), S Garcia Zamora (Buenos Aires,AR), J Thierer (Buenos Aires,AR), EJ Zaidel (Buenos Aires,AR), J Bonorino (Buenos Aires,AR)

Authors:
P Alarcon1 , JA Bilbao1 , R Melchiori1 , IM Cigalini1 , CE Scatularo1 , JC Jauregui1 , MI Bernal1 , JM Aboy1 , J Ortego1 , P Schmidt1 , AV Figueroa1 , S Garcia Zamora1 , J Thierer1 , EJ Zaidel1 , J Bonorino1 , 1Argentine Council of Cardiology Residents (CONAREC) - Buenos Aires - Argentina ,

Citation:

BACKGROUND: Many electrocardiographic (ECG) patterns may be present in acute pulmonary embolism (PE), but their prevalence and association with in hospital mortality (IHM) are less well established.
OBJECTIVE: Assess the correlation between different ECG patterns and IHM in patients (Pts) with PE using a whole country dataset.
METHODS: Prospective multicenter registry which included Pts with acute PE hospitalized in 75 academic centers from October 2016 to November 2017. We considered the following ECG patterns: sinus tachycardia, pulmonary P waves, Q waves in DII-aVF leads, negative T waves in V1-V4, ST segment elevation in aVR and V1, atrial fibrillation or atrial flutter (AF/AF), right bundle branch block (RBBB), ST segment depression, S1Q3T3 pattern or Qr in V1. Statistical analysis was carried out using de STATA version 13.1. A value of p< 0.0.5 was considered statistically significant.
RESULTS: We included 684 Pts; mean age 63.8±16.7 years (43% male). Global IHM was 12%. The most prevalent ECG patterns were sinus tachycardia (51.7%), S1Q3T3 (24.5%), negative T waves in V1- V4 (16%), RBBB (9.9%), AF/AF (8.6%). Four ECG patterns remained statistically significant predictors of IHM on multivariate analysis: AF/AF (OR: 3.81; CI 95% 1.82-7.95, p< 0.01), pulmonary P waves (OR: 3.81; CI 95% 1.2-12, p< 0.04), RBBB (OR: 2.71; CI 95% 1.39-5.30, p< 0.01) and sinus tachycardia (OR: 2.05; CI 95% 1.18-3.54, p< 0.04).
CONCLUSIONS: We corroborate the usefulness of the ECG as a prognostic tool in acute PE. Four simple ECG patterns (AF/AF, Pulmonary P waves, RBBB and sinus tachycardia) were associated with a higher IHM and therefore should be considered for PE risk stratification.

Electrocardiographic pattern OR CI 95% p value
AF/AF 3.81 1.82-7.95 <0.01
Pulmonary P waves 3.81 1.20-12.00 <0.04
RBBB 2.71 1.39-5.30 <0.01
Sinus tachycardia 2.05 1.18-3.54 <0.04
Q waves in DII-aVF 0.93 0.32-2.64 0.89
ST segment depression 1.07 0.39-2.96 0.80
Negative T waves in V1-V4 0.93 0.47-1.81 0.83
S1Q3T3 pattern 0.75 0.39-1.41 0.37
Qr in V1 2.07 0.63-6.73 0.22
ST segment elevation in aVR 2.38 0.79-7.15 0.12
ECG pattern and in-hospital mortality. Multivariate analysis

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