Role of the 12-lead electrocardiogram in diagnosing pulmonary embolism.
We investigated the role of the standard 12-lead electrocardiogram (ECG) to improve the pretest probability of pulmonary embolism before performing computed tomographic (CT) pulmonary angiography. A retrospective chart analysis was performed on patients who underwent CT pulmonary angiography at a tertiary care hospital during a 30-month period. Comparison of 15 ECG parameters was made between those with CT pulmonary angiograms positive for pulmonary embolism and a matched control group with negative CT pulmonary angiograms. Data were analyzed by chi-squared tests and logistic regression. Sinus tachycardia (39% vs. 24%, P <0.01), an S1 Q3 T3 pattern (12% vs. 3%, P <0.01), atrial tachyarrhythmias (15% vs. 4%, P <0.005), a Q wave in lead III (40% vs. 26%, P <0.02), and a Q3 T3 pattern (8% vs. 1%, P <0.02) were the findings significantly associated with pulmonary embolism. We conclude that 1) standard 12-lead ECG findings can increase the pretest probability of pulmonary embolism before performing CT pulmonary angiography; and that 2) the ECG findings have relatively low likelihood ratios to have clinical use.
Sinha
Neeraj
N
Department of Internal Medicine, Division of Cardiothoracic Surgery, Westchester Medical Center/New York Medical College, Valhalla, NY 10595, USA.
Yalamanchili
Kiran
K
Sukhija
Rishi
R
Aronow
Wilbert S
WS
Fleisher
Arlen G
AG
Maguire
George P
GP
Lehrman
Stuart G
SG
D000208:Acute Disease; D000792:Angiography; D016022:Case-Control Studies; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed