title: Electrocardiogram score predicts severity of pulmonary embolism in hemodynamically stable patients.
abstract: BACKGROUND
  Risk stratification of patients with pulmonary embolism (PE) is essential to guide therapy. The presence of right ventricle dysfunction (RVD) and the anatomic extent of PE have been suggested to predict clinical course. The aim of this study was to assess the ability of an electrocardiogram (ECG) scoring system to predict RVD or the clot load score in normotensive patients with PE.
  
  
  METHODS
  Consecutive patients presenting to the emergency room with PE and hemodynamic stability were prospectively included. ECG, echocardiography and computed tomography pulmonary angiography (CTPA) were performed on all patients.
  
  
  RESULTS
  A total of 103 patients were studied. ECG score correlated significantly with the clot load score (r = 0.41, 95% confidence interval [CI]: 0.22-0.57, P < 0.001), systolic pulmonary artery pressure (r= 0.31, 95% CI: 0.09-0.49, P = 0.006), pulmonary artery diameter (r = 0.28, 95% CI: 0.07-0.47, P = 0.011) and right ventricle to left ventricle ratio, both measured with echocardiography (r = 0.42, 95% CI: 0.22-0.57, P < 0.001) and with CTPA (r= 0.36, 95% CI: 0.13-0.56, P = 0.004). Area under the receiver operating characteristic curve for detecting RVD was 0.82 (95% CI: 0.72-0.89). Interobserver agreement regarding ECG score was substantial (κ = 0.80).
  
  
  CONCLUSIONS
  ECG score correlates with the severity of PE in hemodynamically stable patients. It is potentially useful for risk-stratification strategies in this setting.
authors.affiliation: Pneumology Service, Complexo Hospitalario Xeral-Calde, Lugo, Spain. rafael.golpe.gomez@sergas.es
authors.forename: Rafael
authors.initials: R
authors.lastname: Golpe
authors.forename: Olalla
authors.initials: O
authors.lastname: Castro-Añón
authors.forename: Luis A
authors.initials: LA
authors.lastname: Pérez-de-Llano
authors.forename: Carlos
authors.initials: C
authors.lastname: González-Juanatey
authors.forename: Manuel
authors.initials: M
authors.lastname: Vázquez-Caruncho
authors.forename: Lidia
authors.initials: L
authors.lastname: Méndez-Marote
authors.forename: María Carmen
authors.initials: MC
authors.lastname: Fariñas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography / Q000379:methods / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000503:physiopathology*; D012720:Severity of Illness Index