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The Diagnostic Predictive Value of R wave peak time in Patients with Acute Pulmonary Embolism

Year 2019, Volume: 41 Issue: 4, 360 - 370, 01.10.2019
https://doi.org/10.20515/otd.440724

Abstract

This
study aimed to investigate the diagnostic predictive value of R wave peak time
(RWPT) in patients admitted to the emergency department with a preliminary
diagnosis of acute pulmonary embolism (APE).



Computerized
tomographic pulmonary angiography (CTPA) was performed in 74 consecutive
patients with suspected APE, and of these 66 patients with appropriate
electrocardiogram (ECG) and CTPA images composed the study population.By using
CTPA, APE was confirmed in 27
patients. While the
atrial arrhythmia, right
axis deviation, complete or incomplete right bundle branch block, prominent S
wave in the lead DI, S1Q3T3 pattern, and RWPT in the lead DIII (40±11 vs. 31±13
ms) were statistically different in patients with APE compared to those without
APE (p<0.05, for all), the other ECG findings were similar. Multivariate
analysis revealed that RWPT in the lead DIII
(odds ratio: 14.959, 95% confidence interval:
1.811–123.582, p=0.012) was found to be an independent predictor of APE. A
receiver operating characteristic
analysis
was drawn to show the best cut-off value of the RWPT in the lead DIII to
predict APE was ≥40 ms with 48.1% sensitivity and 87.2 % specificity (area
under curve (AUC): 0.718; 95% CI: 0.593–0.843; p=0.003).
The
present study demonstrated that the RWPT in the lead DIII may have diagnostic
predictive value for APE. In addition, it may be useful in electrocardiographic
signs for the diagnosis of APE.

References

  • REFERENCES
  • 1. Torbicki A. (Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J. 2008;29:2276-315.
  • 2. Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT, et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991;100(3):598-603.
  • 3. Van Mieghem C, Sabbe M, Knockaert D. The clinical value of the ECG in noncardiac conditions. Chest. 2004;125(4):1561-76.
  • 4. Can MM, Ozveren O, Biteker M, Sengul C, Uz O, Isilak Z, et al. Role of electrocardiographic changes in discriminating acute or chronic right ventricular pressure overload. Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology. 2013;13(4):344-9.
  • 5. Sreeram N, Cheriex EC, Smeets JL, Gorgels AP, Wellens HJ. Value of the 12-lead electrocardiogram at hospital admission in the diagnosis of pulmonary embolism. American Journal of Cardiology. 1994;73(4):298-303.
  • 6. Sinha N, Yalamanchili K, Sukhija R, Aronow WS, Fleisher AG, Maguire GP, et al. Role of the 12-lead electrocardiogram in diagnosing pulmonary embolism. Cardiology in review. 2005;13(1):46-9.
  • 7. Sadeghpour A, Alizadeasl A. Can isolated ST elevation in aVR lead be a sign of acute pulmonary embolism? Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology. 2013;13(3):288-9.
  • 8. Macleod A, Wilson FN, Barker PS. The form of the electrocardiogram. I. Intrinsicoid electrocardiographic deflections in animals and man. Proceedings of the Society for Experimental Biology and Medicine. 1930;27(6):586-7.
  • 9. Pérez‐Riera AR, Abreu LC, Barbosa‐Barros R, Nikus KC, Baranchuk A. R‐Peak Time: An Electrocardiographic Parameter with Multiple Clinical Applications. Annals of Noninvasive Electrocardiology. 2016;21(1):10-9.
  • 10. Rencüzoğulları İ, Çağdaş M, Karakoyun S, Karabağ Y, Yesin M, Artaç İ, et al. The association between electrocardiographic R wave peak time and coronary artery disease severity in patients with non-ST segment elevation myocardial infarction and unstable angina pectoris. Journal of electrocardiology. 2017.
  • 11. Oh JK SJ, Tajik AJ., editor. The Echo Manual. 3rd ed. Philadelphia, PA: WWW; 2009.
  • 12. Stein PD, Henry JW. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest. 1995;108(4):978-81.
  • 13. Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thrombosis and haemostasis. 2000;83(03):416-20.
  • 14. Le Gal G, Righini M, Roy P-M, Sanchez O, Aujesky D, Bounameaux H, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Annals of internal medicine. 2006;144(3):165-71.
  • 15. Patel S, Kazerooni EA, Cascade PN. Pulmonary embolism: optimization of small pulmonary artery visualization at multi–detector row CT. Radiology. 2003;227(2):455-60.
  • 16. Ullman E, Brady WJ, Perron AD, Chan T, Mattu A. Electrocardiographic manifestations of pulmonary embolism. The American journal of emergency medicine. 2001;19(6):514-9.
  • 17. Rodger M, Makropoulos D, Turek M, Quevillon J, Raymond F, Rasuli P, et al. Diagnostic value of the electrocardiogram in suspected pulmonary embolism. The American journal of cardiology. 2000;86(7):807-9.
  • 18. Zhan Z-Q, Wang C-Q, Wang Z-X. Diagnosing acute pulmonary embolism masquerading as inferior myocardial infarction. The American journal of emergency medicine. 2015;33(8):1114. e5-. e6.
  • 19. Kosuge M, Ebina T, Hibi K, Tsukahara K, Iwahashi N, Umemura S, et al. Differences in negative T waves between acute pulmonary embolism and acute coronary syndrome. Circulation Journal. 2014;78(2):483-9.
  • 20. Hariharan P, Dudzinski DM, Okechukwu I, Takayesu JK, Chang Y, Kabrhel C. Association Between Electrocardiographic Findings, Right Heart Strain, and Short‐Term Adverse Clinical Events in Patients With Acute Pulmonary Embolism. Clinical cardiology. 2015;38(4):236-42.
  • 21. Holland R, Brooks H. The QRS complex during myocardial ischemia. An experimental analysis in the porcine heart. The Journal of clinical investigation. 1976;57(3):541-50.

Akut Pulmoner Embolili Hastalarda R Dalga Pik Zamanının Tanısal Öngörücü Değeri

Year 2019, Volume: 41 Issue: 4, 360 - 370, 01.10.2019
https://doi.org/10.20515/otd.440724

Abstract

Bu
çalışmada,  akut pulmoner emboli (APE) ön
tanısı ile acil servise başvuran hastalarda R dalga pik zamanın (RDPZ) tanısal
değerini araştırmayı amaçladık. APE şüphesi ile ardışık 74 hastaya bilgisayarlı
tomografik pulmoner anjiyografi (BTPA) uygulandı ve bu hastalardan uygun
elektrokardiyografi (EKG) ve BTPA görüntüleri olan 66 hasta çalışma nüfusunu
oluşturdu. BTPA kullanılarak 27 hastada APE doğrulandı. Atrial aritmi, sağ aks
deviyasyonu, komple ve in komple sağ dal bloğu, DI derivasyonunda belirgin S
dalgası, S1Q3T3 bulgusu ve DIII derivasyonunda RDPZ
(40±11
vs. 31±13 ms) APE hastalarında istatistiksel olarak farklı iken (p<0.05,
hepsi), diğer EKG bulguları benzerdi. Çoklu değişken analizi, DIII
derivasyonunda ki RDPZ APE’nin bağımsız öngörücü olarak bulundu
(Odd oranı: 14.959, 95% Güven Aralığı:
1.811–123.582, p=0.012)
. Karar vericinin etkinliği
(KVE) eğrisi
çizilerek RDPZ değerinin APE’nin
en iyi öngörücü değeri %87,2’lük duyarlılık ve %48,1’lük bir özgüllük ile
>=40 ms olarak saptandı (Eğri altında kalan alan (EAK): 0.718, 95% CI:
0.593-0.843; p=0.003). Bu çalışma DIII derivasyonunda RDPZ’nın tanısal değeri
olabileceğini göstermiştir. Bunun yanında, 
RDPZ’ı APE’nin tanısı için yararlı bir elektrografik bulgu olabilir.

References

  • REFERENCES
  • 1. Torbicki A. (Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J. 2008;29:2276-315.
  • 2. Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT, et al. Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest. 1991;100(3):598-603.
  • 3. Van Mieghem C, Sabbe M, Knockaert D. The clinical value of the ECG in noncardiac conditions. Chest. 2004;125(4):1561-76.
  • 4. Can MM, Ozveren O, Biteker M, Sengul C, Uz O, Isilak Z, et al. Role of electrocardiographic changes in discriminating acute or chronic right ventricular pressure overload. Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology. 2013;13(4):344-9.
  • 5. Sreeram N, Cheriex EC, Smeets JL, Gorgels AP, Wellens HJ. Value of the 12-lead electrocardiogram at hospital admission in the diagnosis of pulmonary embolism. American Journal of Cardiology. 1994;73(4):298-303.
  • 6. Sinha N, Yalamanchili K, Sukhija R, Aronow WS, Fleisher AG, Maguire GP, et al. Role of the 12-lead electrocardiogram in diagnosing pulmonary embolism. Cardiology in review. 2005;13(1):46-9.
  • 7. Sadeghpour A, Alizadeasl A. Can isolated ST elevation in aVR lead be a sign of acute pulmonary embolism? Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology. 2013;13(3):288-9.
  • 8. Macleod A, Wilson FN, Barker PS. The form of the electrocardiogram. I. Intrinsicoid electrocardiographic deflections in animals and man. Proceedings of the Society for Experimental Biology and Medicine. 1930;27(6):586-7.
  • 9. Pérez‐Riera AR, Abreu LC, Barbosa‐Barros R, Nikus KC, Baranchuk A. R‐Peak Time: An Electrocardiographic Parameter with Multiple Clinical Applications. Annals of Noninvasive Electrocardiology. 2016;21(1):10-9.
  • 10. Rencüzoğulları İ, Çağdaş M, Karakoyun S, Karabağ Y, Yesin M, Artaç İ, et al. The association between electrocardiographic R wave peak time and coronary artery disease severity in patients with non-ST segment elevation myocardial infarction and unstable angina pectoris. Journal of electrocardiology. 2017.
  • 11. Oh JK SJ, Tajik AJ., editor. The Echo Manual. 3rd ed. Philadelphia, PA: WWW; 2009.
  • 12. Stein PD, Henry JW. Prevalence of acute pulmonary embolism among patients in a general hospital and at autopsy. Chest. 1995;108(4):978-81.
  • 13. Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Thrombosis and haemostasis. 2000;83(03):416-20.
  • 14. Le Gal G, Righini M, Roy P-M, Sanchez O, Aujesky D, Bounameaux H, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Annals of internal medicine. 2006;144(3):165-71.
  • 15. Patel S, Kazerooni EA, Cascade PN. Pulmonary embolism: optimization of small pulmonary artery visualization at multi–detector row CT. Radiology. 2003;227(2):455-60.
  • 16. Ullman E, Brady WJ, Perron AD, Chan T, Mattu A. Electrocardiographic manifestations of pulmonary embolism. The American journal of emergency medicine. 2001;19(6):514-9.
  • 17. Rodger M, Makropoulos D, Turek M, Quevillon J, Raymond F, Rasuli P, et al. Diagnostic value of the electrocardiogram in suspected pulmonary embolism. The American journal of cardiology. 2000;86(7):807-9.
  • 18. Zhan Z-Q, Wang C-Q, Wang Z-X. Diagnosing acute pulmonary embolism masquerading as inferior myocardial infarction. The American journal of emergency medicine. 2015;33(8):1114. e5-. e6.
  • 19. Kosuge M, Ebina T, Hibi K, Tsukahara K, Iwahashi N, Umemura S, et al. Differences in negative T waves between acute pulmonary embolism and acute coronary syndrome. Circulation Journal. 2014;78(2):483-9.
  • 20. Hariharan P, Dudzinski DM, Okechukwu I, Takayesu JK, Chang Y, Kabrhel C. Association Between Electrocardiographic Findings, Right Heart Strain, and Short‐Term Adverse Clinical Events in Patients With Acute Pulmonary Embolism. Clinical cardiology. 2015;38(4):236-42.
  • 21. Holland R, Brooks H. The QRS complex during myocardial ischemia. An experimental analysis in the porcine heart. The Journal of clinical investigation. 1976;57(3):541-50.
There are 22 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section ORİJİNAL MAKALE
Authors

Yavuz Karabağ 0000-0002-8156-315X

Tufan Çınar 0000-0001-8188-5020

Metin Çağdaş 0000-0001-6704-9886

İbrahim Rencüzoğulları 0000-0002-0070-9197

Publication Date October 1, 2019
Published in Issue Year 2019 Volume: 41 Issue: 4

Cite

Vancouver Karabağ Y, Çınar T, Çağdaş M, Rencüzoğulları İ. The Diagnostic Predictive Value of R wave peak time in Patients with Acute Pulmonary Embolism. Osmangazi Tıp Dergisi. 2019;41(4):360-7.


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