Piotr Kukla1, William F McIntyre2, Kamil Fijorek3, Ewa Mirek-Bryniarska4, Leszek Bryniarski5, Ewa Krupa6, Marek Jastrzębski5, Krzysztof L Bryniarski7, Zhan Zhong-qun8, Adrian Baranchuk9. 1. Department of Cardiology, Specialistic Hospital, Gorlice, Poland. Electronic address: kukla_piotr@poczta.onet.pl. 2. Department of Internal Medicine, Section of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada. 3. Department of Statistics, Cracow University of Economics, Cracow, Poland. 4. Department of Cardiology, Dietl's Hospital, Cracow, Poland. 5. First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Cracow, Poland. 6. Department of Cardiology, Szczeklik Hospital, Tarnow, Poland. 7. First Department of Internal Medicine, Dietl's Hospital, Cracow, Poland. 8. Department Of Cardiology, Shiyan Taihe Hospital, Hubei University of Medicine, Hubei Province, China. 9. Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
Abstract
BACKGROUND: Cardiogenic shock (CS) is a predictor of poor prognosis in patients with acute pulmonary embolism (APE). OBJECTIVES: The aim of this study was to compare electrocardiography (ECG) parameters in patients with APE presenting with or without CS. METHODS: A 12-lead ECG was recorded on admission at a paper speed of 25 mm/s and 10 mm/mV amplification. All ECGs were examined by a single cardiologist who was blinded to all other clinical data. All ECG measurements were made manually. RESULTS: Electrocardiographic data from 500 patients with APE were analyzed, including 92 patients with CS. The following ECG parameters were associated with CS: S1Q3T3 sign, (odds ratio [OR]: 2.85, P<.001), qR or QR morphology of QRS in lead V1, (OR: 3.63, P<.001), right bundle branch block (RBBB) (OR: 2.46, P=.004), QRS fragmentation in lead V1 (OR: 2.94, P=.002), low QRS voltage (OR: 3.21, P<.001), negative T waves in leads V2 to V4 (OR: 1.81, P=.011), ST-segment depression in leads V4 to V6 (OR: 3.28, P<.001), ST-segment elevation in lead III (OR: 4.2, P<.001), ST-segment elevation in lead V1 (OR: 6.78, P<.01), and ST-segment elevation in lead aVR (OR: 4.35, P<.01). The multivariate analysis showed that low QRS voltage, RBBB, and ST-segment elevation in lead V1 remained statistically significant predictors of CS. CONCLUSIONS: In patients with APE, low QRS voltage, RBBB, and ST-segment elevation in lead V1 were associated with CS.
BACKGROUND:Cardiogenic shock (CS) is a predictor of poor prognosis in patients with acute pulmonary embolism (APE). OBJECTIVES: The aim of this study was to compare electrocardiography (ECG) parameters in patients with APE presenting with or without CS. METHODS: A 12-lead ECG was recorded on admission at a paper speed of 25 mm/s and 10 mm/mV amplification. All ECGs were examined by a single cardiologist who was blinded to all other clinical data. All ECG measurements were made manually. RESULTS: Electrocardiographic data from 500 patients with APE were analyzed, including 92 patients with CS. The following ECG parameters were associated with CS: S1Q3T3 sign, (odds ratio [OR]: 2.85, P<.001), qR or QR morphology of QRS in lead V1, (OR: 3.63, P<.001), right bundle branch block (RBBB) (OR: 2.46, P=.004), QRS fragmentation in lead V1 (OR: 2.94, P=.002), low QRS voltage (OR: 3.21, P<.001), negative T waves in leads V2 to V4 (OR: 1.81, P=.011), ST-segment depression in leads V4 to V6 (OR: 3.28, P<.001), ST-segment elevation in lead III (OR: 4.2, P<.001), ST-segment elevation in lead V1 (OR: 6.78, P<.01), and ST-segment elevation in lead aVR (OR: 4.35, P<.01). The multivariate analysis showed that low QRS voltage, RBBB, and ST-segment elevation in lead V1 remained statistically significant predictors of CS. CONCLUSIONS: In patients with APE, low QRS voltage, RBBB, and ST-segment elevation in lead V1 were associated with CS.
Authors: Geneviève C Digby; Piotr Kukla; Zhong-Qun Zhan; Carlos A Pastore; Ryszard Piotrowicz; Edgardo Schapachnik; Wojciech Zareba; Antonio Bayés de Luna; Piotr Pruszczyk; Adrian M Baranchuk Journal: Ann Noninvasive Electrocardiol Date: 2015-05 Impact factor: 1.468
Authors: Amro Qaddoura; Geneviève C Digby; Conrad Kabali; Piotr Kukla; Gary Tse; Benedict Glover; Adrian M Baranchuk Journal: Ann Noninvasive Electrocardiol Date: 2018-04-19 Impact factor: 1.468
Authors: Raphael R Bruno; Norbert Donner-Banzhoff; Wolfgang Söllner; Thomas Frieling; Christian Müller; Michael Christ Journal: Dtsch Arztebl Int Date: 2015-11-06 Impact factor: 5.594