Piotr Kukla1, Dariusz A Kosior2, Andrzej Tomaszewski3, Katarzyna Ptaszyńska-Kopczyńska4, Katarzyna Widejko5, Robert Długopolski6, Andrzej Skrzyński7, Piotr Błaszczak8, Kamil Fijorek9, Marcin Kurzyna10. 1. Department of Cardiology and Internal Medicine, Specialist Hospital, Gorlice, Poland. 2. Faculty of Medicine, Lazarski University, Warsaw, Poland. 3. Cardiology Department, Medical University of Lublin, Lublin, Poland. 4. Department of Cardiology, Medical University of Bialystok, Bialystok, Poland. 5. Department of Cardiology, Health Center MCZ, Lubin, Poland. 6. Department of Internal Medicine, City Hospital, Rabka-Zdrój, Poland. 7. Independent Public Healthcare Centre Lukow, Lukow, Poland. 8. Department of Cardiology, Cardinal Wyszynski' Hospital, Lublin, Poland. 9. Department of Statistics, Cracow University of Economics, Cracow, Poland. 10. Department of Pulmonary Circulation and Thromboembolic Diseases, The Medical Centre of Postgraduate Medication, European Health Centre Otwock, Otwock, Poland.
Abstract
BACKGROUND: Electrocardiography (ECG) is still one of the first tests performed at admission, mostly in patients (pts) with chest pain or dyspnea. The aim of this study was to assess the correlation between electrocardiographic abnormalities and cardiac biomarkers as well as echocardiographic parameter in patients with acute pulmonary embolism. METHODS: We performed a retrospective analysis of 614 pts. (F/M 334/280; mean age of 67.9 ± 16.6 years) with confirmed acute pulmonary embolism (APE) who were enrolled to the ZATPOL-2 Registry between 2012 and 2014. RESULTS: Elevated cardiac biomarkers were observed in 358 pts (74.4%). In this group the presence of atrial fibrillation (p = .008), right axis deviation (p = .004), S1 Q3 T3 sign (p < .001), RBBB (p = .006), ST segment depression in leads V4 -V6 (p < .001), ST segment depression in lead I (p = .01), negative T waves in leads V1 -V3 (p < .001), negative T waves in leads V4 -V6 (p = .005), negative T waves in leads II, III and aVF (p = .005), ST segment elevation in lead aVR (p = .002), ST segment elevation in lead III (p = .0038) was significantly more frequent in comparison to subjects with normal serum level of cardiac biomarkers. In multivariate regression analysis, clinical predictors of "abnormal electrocardiogram" were as follows: increased heart rate (OR 1.09, 95% CI 1.02-1.17, p = .012), elevated troponin concentration (OR 3.33, 95% CI 1.94-5.72, p = .000), and right ventricular overload (OR 2.30, 95% CI 1.17-4.53, p = .016). CONCLUSIONS: Electrocardiographic signs of right ventricular strain are strongly related to elevated cardiac biomarkers and echocardiographic signs of right ventricular overload. ECG may be used in preliminary risk stratification of patient with intermediate- or high-risk forms of APE.
BACKGROUND: Electrocardiography (ECG) is still one of the first tests performed at admission, mostly in patients (pts) with chest pain or dyspnea. The aim of this study was to assess the correlation between electrocardiographic abnormalities and cardiac biomarkers as well as echocardiographic parameter in patients with acute pulmonary embolism. METHODS: We performed a retrospective analysis of 614 pts. (F/M 334/280; mean age of 67.9 ± 16.6 years) with confirmed acute pulmonary embolism (APE) who were enrolled to the ZATPOL-2 Registry between 2012 and 2014. RESULTS: Elevated cardiac biomarkers were observed in 358 pts (74.4%). In this group the presence of atrial fibrillation (p = .008), right axis deviation (p = .004), S1 Q3 T3 sign (p < .001), RBBB (p = .006), ST segment depression in leads V4 -V6 (p < .001), ST segment depression in lead I (p = .01), negative T waves in leads V1 -V3 (p < .001), negative T waves in leads V4 -V6 (p = .005), negative T waves in leads II, III and aVF (p = .005), ST segment elevation in lead aVR (p = .002), ST segment elevation in lead III (p = .0038) was significantly more frequent in comparison to subjects with normal serum level of cardiac biomarkers. In multivariate regression analysis, clinical predictors of "abnormal electrocardiogram" were as follows: increased heart rate (OR 1.09, 95% CI 1.02-1.17, p = .012), elevated troponin concentration (OR 3.33, 95% CI 1.94-5.72, p = .000), and right ventricular overload (OR 2.30, 95% CI 1.17-4.53, p = .016). CONCLUSIONS: Electrocardiographic signs of right ventricular strain are strongly related to elevated cardiac biomarkers and echocardiographic signs of right ventricular overload. ECG may be used in preliminary risk stratification of patient with intermediate- or high-risk forms of APE.
Authors: Piotr Kukla; Robert Długopolski; Ewa Krupa; Romana Furtak; Roman Szełemej; Ewa Mirek-Bryniarska; Marek Jastrzębski; Jacek Nowak; Piotr Wańczura; Leszek Bryniarski Journal: Cardiol J Date: 2011 Impact factor: 2.737
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: Stavros V Konstantinides; Adam Torbicki; Giancarlo Agnelli; Nicolas Danchin; David Fitzmaurice; Nazzareno Galiè; J Simon R Gibbs; Menno V Huisman; Marc Humbert; Nils Kucher; Irene Lang; Mareike Lankeit; John Lekakis; Christoph Maack; Eckhard Mayer; Nicolas Meneveau; Arnaud Perrier; Piotr Pruszczyk; Lars H Rasmussen; Thomas H Schindler; Pavel Svitil; Anton Vonk Noordegraaf; Jose Luis Zamorano; Maurizio Zompatori Journal: Eur Heart J Date: 2014-08-29 Impact factor: 29.983
Authors: Piotr Kukla; Dariusz A Kosior; Andrzej Tomaszewski; Katarzyna Ptaszyńska-Kopczyńska; Katarzyna Widejko; Robert Długopolski; Andrzej Skrzyński; Piotr Błaszczak; Kamil Fijorek; Marcin Kurzyna Journal: Ann Noninvasive Electrocardiol Date: 2017-02-18 Impact factor: 1.468
Authors: Piotr Kukla; Dariusz A Kosior; Andrzej Tomaszewski; Katarzyna Ptaszyńska-Kopczyńska; Katarzyna Widejko; Robert Długopolski; Andrzej Skrzyński; Piotr Błaszczak; Kamil Fijorek; Marcin Kurzyna Journal: Ann Noninvasive Electrocardiol Date: 2017-02-18 Impact factor: 1.468