The best predictor for right ventricular dysfunction in acute pulmonary embolism: comparison between electrocardiography and biomarkers.
OBJECTIVE
Right ventricular (RV) dysfunction is associated with a poor prognosis in patients with an acute pulmonary embolism (APE). We studied the role of electrocardiography and biomarkers for early detection and recovery of right ventricular dysfunction (RVD) in APE.


METHODS
The medical records of 48 consecutive patients diagnosed with APE using CT-angiography, at the Kangdong Sacred Heart Hospital, between January 2004 and February 2008 were reviewed retrospectively. RVD was assessed by serial echocardiography (ECG). Patients with one of the following were considered to have RVD: 1) RV dilatation (enddiastolic diameter >30 mm in the parasternal long axis view), 2) RV free wall hypokinesia, and 3) paradoxical septal systolic motion. We compared the electrocardiographic findings and the biomarkers for the early detection of RVD.


RESULTS
The electrocardiographic findings showed T-wave inversion (TWI) in leads V1 to V3 with a sensitivity of 75% and a specificity of 95%, and a diagnostic accuracy of 80% for the detection of RVD, with positive and negative predictive values of 95.5% and 73.1%, respectively; these results were better than the biomarkers such as cardiac enzymes or B-type natriuretic peptide (BNP) for the early detection of RVD. TWIs persisted throughout the period of RVD, in contrast to a transient S1Q3T3 pattern detected during the acute phase only.


CONCLUSIONS
TWIs in leads V1 to V3 had the greatest sensitivity and diagnostic accuracy for early detection of RVD, and normalization of the TWIs was associated with recovery of RVD in APE.
Kim
Sung Eun
SE
Department of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Park
Dae Gyun
DG
Choi
Hyun Hee
HH
Yoon
Duck Hyoung
DH
Lee
Jun Hee
JH
Han
Kyoo Rok
KR
Oh
Dong Jin
DJ
Hong
Kyung Soon
KS