open access

Vol 69, No 7 (2011)
Original articles
Published online: 2011-07-18
Submitted: 2012-12-28
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The prognostic value of ST−segment elevation in the lead aVR in patients with acute pulmonary embolism

Piotr Kukla, Robert Długopolski, Ewa Krupa, Romana Furtak, Ewa Mirek-Bryniarska, Marek Jastrzębski, Piotr Wańczura, Leszek Bryniarski
Kardiol Pol 2011;69(7):649-654.

open access

Vol 69, No 7 (2011)
Original articles
Published online: 2011-07-18
Submitted: 2012-12-28

Abstract

Background: Electrocardiogram (ECG) in patients with acute pulmonary embolism (APE) presents many abnormalities. There are no data concerning prognostic significance of ST-elevation (STE) in lead aVR in patients with APE.
Aim: To assess the prevalence of STE in aVR in patients with APE and its correlation with clinical course as well as other ECG parameters recorded at admission.
Methods: The retrospective analysis of 293 patients with APE diagnosed according to the ESC guidelines (182 females, 111 males, mean age 65.4 ± 15.5 years).
Results: The STE in lead aVR was observed in 133 (45.3%) patients. In comparison with patients without STE, patients with STE in lead aVR (STaVR[+]) had significantly more often systolic blood pressure < 90 mm Hg on admission (27% vs 10%, p < 0.001) and positive troponin level (64.8% vs 27.9%, p < 0.001). Thrombolytic therapy (14.3% vs 5.6%, p = 0.009) and catecholamines (29.3% vs 7.5%, p < 0.001) were more frequently used in patients with STaVR(+). The overall mortality (16.5% vs 6.9%, p = 0.009) and complication rates during hospitalisation (38.3% vs 12.5%, p < 0.001) were significantly higher in patients with STaVR(+). The STaVR(+) was significantly more frequent in patients with negative T-waves in inferior leads (59.4% vs 39.4%, p < 0.001), STE in lead III (24% vs 5.6%, p < 0.001), STE in lead V1 (46.6% vs 7.5%, p < 0.001), ST depression in lead V4–V6 (48.9% vs 7.5%, p < 0.001), right bundle branch block (15.8% vs 8.1%, p = 0.04), QR sign in lead V1 (18% vs 6.2%, p < 0.001) and SI-QIII-TIII (46.6% vs 21.2%, p < 0.001).
Conclusions: The presence of STE in lead aVR in patients with APE is associated with poor prognosis. The presence of STE in lead aVR could be an easily obtainable and noninvasive ECG parameter, helpful in risk stratification of patients with APE.
Kardiol Pol 2011; 69, 7: 649–654

Abstract

Background: Electrocardiogram (ECG) in patients with acute pulmonary embolism (APE) presents many abnormalities. There are no data concerning prognostic significance of ST-elevation (STE) in lead aVR in patients with APE.
Aim: To assess the prevalence of STE in aVR in patients with APE and its correlation with clinical course as well as other ECG parameters recorded at admission.
Methods: The retrospective analysis of 293 patients with APE diagnosed according to the ESC guidelines (182 females, 111 males, mean age 65.4 ± 15.5 years).
Results: The STE in lead aVR was observed in 133 (45.3%) patients. In comparison with patients without STE, patients with STE in lead aVR (STaVR[+]) had significantly more often systolic blood pressure < 90 mm Hg on admission (27% vs 10%, p < 0.001) and positive troponin level (64.8% vs 27.9%, p < 0.001). Thrombolytic therapy (14.3% vs 5.6%, p = 0.009) and catecholamines (29.3% vs 7.5%, p < 0.001) were more frequently used in patients with STaVR(+). The overall mortality (16.5% vs 6.9%, p = 0.009) and complication rates during hospitalisation (38.3% vs 12.5%, p < 0.001) were significantly higher in patients with STaVR(+). The STaVR(+) was significantly more frequent in patients with negative T-waves in inferior leads (59.4% vs 39.4%, p < 0.001), STE in lead III (24% vs 5.6%, p < 0.001), STE in lead V1 (46.6% vs 7.5%, p < 0.001), ST depression in lead V4–V6 (48.9% vs 7.5%, p < 0.001), right bundle branch block (15.8% vs 8.1%, p = 0.04), QR sign in lead V1 (18% vs 6.2%, p < 0.001) and SI-QIII-TIII (46.6% vs 21.2%, p < 0.001).
Conclusions: The presence of STE in lead aVR in patients with APE is associated with poor prognosis. The presence of STE in lead aVR could be an easily obtainable and noninvasive ECG parameter, helpful in risk stratification of patients with APE.
Kardiol Pol 2011; 69, 7: 649–654
Get Citation

Keywords

acute pulmonary embolism; lead aVR; ECG; mortality

About this article
Title

The prognostic value of ST−segment elevation in the lead aVR in patients with acute pulmonary embolism

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 69, No 7 (2011)

Pages

649-654

Published online

2011-07-18

Bibliographic record

Kardiol Pol 2011;69(7):649-654.

Keywords

acute pulmonary embolism
lead aVR
ECG
mortality

Authors

Piotr Kukla
Robert Długopolski
Ewa Krupa
Romana Furtak
Ewa Mirek-Bryniarska
Marek Jastrzębski
Piotr Wańczura
Leszek Bryniarski

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