title: QR in V1--an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism.
abstract: OBJECTIVE
  To test the hypothesis that Qr in V(1)is a predictor of pulmonary embolism, right ventricular strain, and adverse clinical outcome.
  
  
  RESULTS
  ECG's from 151 patients with suspected pulmonary embolism were blindly interpreted by two observers. Echocardiography, troponin I, and pro-brain natriuretic peptide levels were obtained in 75 patients with pulmonary embolism. Qr in V(1)(14 vs 0 in controls; p<0.0001) and ST elevation in V(1)> or =1 mV (15 vs 1 in controls; p=0.0002) were more frequently present in patients with pulmonary embolism. Sensitivity and specificity of Qr in V(1)and T wave inversion in V(2)for predicting right ventricular dysfunction were 31/97% and 45/94%, respectively. Three of five patients who died in-hospital and 11 of 20 patients with a complicated course, presented with Qr in V(1). After adjustment for right ventricular strain including ECG, echocardiography, pro-brain natriuretic peptide and troponin I levels, Qr in V(1)(OR 8.7, 95%CI 1.4-56.7; p=0.02) remained an independent predictor of adverse outcome.
  
  
  CONCLUSIONS
  Among the ECG signs seen in patients with acute pulmonary embolism, Qr in V(1)is closely related to the presence of right ventricular dysfunction, and is an independent predictor of adverse clinical outcome.
authors.affiliation: Cardiology, Swiss Cardiovascular Center Bern, University Hospital, 3010 Bern, Switzerland. nkucher@freesurf.ch
authors.forename: Nils
authors.initials: N
authors.lastname: Kucher
authors.forename: Nazan
authors.initials: N
authors.lastname: Walpoth
authors.forename: Kerstin
authors.initials: K
authors.lastname: Wustmann
authors.forename: Markus
authors.initials: M
authors.lastname: Noveanu
authors.forename: Marc
authors.initials: M
authors.lastname: Gertsch
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology*; D004452:Echocardiography; D004562:Electrocardiography; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D015588:Observer Variation; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000503:physiopathology; D036542:Tomography, Spiral Computed / Q000379:methods; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D