Prognostic Value of Electrocardiography in Elderly Patients with Acute Pulmonary Embolism.

Détails

ID Serval
serval:BIB_CAFDC1764B23
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Prognostic Value of Electrocardiography in Elderly Patients with Acute Pulmonary Embolism.
Périodique
The American journal of medicine
Auteur(s)
Bolt L., Lauber S., Limacher A., Samim D., Löwe A., Tritschler T., Baumgartner C., Aujesky D.
ISSN
1555-7162 (Electronic)
ISSN-L
0002-9343
Statut éditorial
Publié
Date de publication
12/2019
Peer-reviewed
Oui
Volume
132
Numéro
12
Pages
e835-e843
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
Electrocardiographic (ECG) signs of right ventricular strain could be used as a simple tool to risk-stratify patients with acute pulmonary embolism.
We studied consecutive patients aged ≥65 years with acute pulmonary embolism in a prospective multicenter cohort study. Two readers independently analyzed 12 predefined ECG signs of right ventricular strain in all patients. The outcome was the occurrence of an adverse clinical event, defined as death from any cause within 90 days or a complicated in-hospital course. We determined the interrater reliability for each ECG sign and examined the association between right ventricular strain signs and adverse events using logistic regression, adjusting for the Pulmonary Embolism Severity Index and cardiac troponin.
Overall, 320/390 patients (82%) showed at least one ECG sign of right ventricular strain. The interrater reliability for individual ECG signs was highly variable (ᴋ 0.40-0.95). Patients with ≥1 of the 3 classic signs of right ventricular strain (S1Q3T3, right bundle branch block, or T wave inversions in V1-V4) had a higher incidence of adverse events than those without (13% vs 6%; P = .026). After adjustment, the presence of ≥1 of the 3 classic signs of right ventricular strain (odds ratio 2.11; 95% confidence interval, 1.00-4.46) and the number of right ventricular strain signs present were significantly associated with adverse events (odds ratio 1.35 per sign; 95% confidence interval, 1.08-1.69).
ECG signs of right ventricular strain are common in elderly patients with acute pulmonary embolism. Although such signs may have prognostic value, their variable reliability and the rather modest prognostic effect size may limit their usefulness in the risk stratification of pulmonary embolism.
Mots-clé
Acute Disease, Aged, Aged, 80 and over, Bundle-Branch Block/diagnostic imaging, Cohort Studies, Electrocardiography/methods, Female, Follow-Up Studies, Geriatric Assessment/methods, Hospital Mortality, Humans, Kaplan-Meier Estimate, Logistic Models, Male, Observer Variation, Prognosis, Prospective Studies, Pulmonary Embolism/diagnosis, Pulmonary Embolism/diagnostic imaging, Survival Analysis, Ventricular Dysfunction, Right/diagnostic imaging, Ventricular Dysfunction, Right/physiopathology, Electrocardiography, Prognostic value, Pulmonary embolism, Right ventricular strain
Pubmed
Web of science
Création de la notice
18/07/2019 17:13
Dernière modification de la notice
05/04/2020 5:20
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