title: The prognostic value of ST-segment elevation in the lead aVR in patients with acute pulmonary embolism.
abstract: BACKGROUND
  Electrocardiogram (ECG) in patients with acute pulmonary embolism (APE) presents many abnormalities. There are no data concerning prognostic significance of ST-elevation (STE) in lead aVR in patients with APE.
  
  
  OBJECTIVE
  To assess the prevalence of STE in aVR in patients with APE and its correlation with clinical course as well as other ECG parameters recorded at admission.
  
  
  METHODS
  The retrospective analysis of 293 patients with APE diagnosed according to the ESC guidelines (182 females, 111 males, mean age 65.4 ± 15.5 years).
  
  
  RESULTS
  The STE in lead aVR was observed in 133 (45.3%) patients. In comparison with patients without STE, patients with STE in lead aVR (STaVR[+]) had significantly more often systolic blood pressure 〈 90 mm Hg on admission (27% vs 10%, p 〈 0.001) and positive troponin level (64.8% vs 27.9%, p 〈 0.001). Thrombolytic therapy (14.3% vs 5.6%, p = 0.009) and catecholamines (29.3% vs 7.5%, p 〈 0.001) were more frequently used in patients with STaVR(+). The overall mortality (16.5% vs 6.9%, p = 0.009) and complication rates during hospitalisation (38.3% vs 12.5%, p 〈 0.001) were significantly higher in patients with STaVR(+). The STaVR(+) was significantly more frequent in patients with negative T-waves in inferior leads (59.4% vs 39.4%, p 〈 0.001), STE in lead III (24% vs 5.6%, p 〈 0.001), STE in lead V1 (46.6% vs 7.5%, p 〈 0.001), ST depression in lead V(4)-V(6) (48.9% vs 7.5%, p 〈 0.001), right bundle branch block (15.8% vs 8.1%, p = 0.04), QR sign in lead V1 (18% vs 6.2%, p 〈 0.001) and SI-QIII-TIII (46.6% vs 21.2%, p 〈 0.001).
  
  
  CONCLUSIONS
  The presence of STE in lead aVR in patients with APE is associated with poor prognosis. The presence of STE in lead aVR could be an easily obtainable and noninvasive ECG parameter, helpful in risk stratification of patients with APE.
authors.affiliation: Department of Internal Diseases and Cardiology, H. Klimontowicz Hospital, Gorlice, Poland. kukla_piotr@poczta.onet.pl
authors.forename: Piotr
authors.initials: P
authors.lastname: Kukla
authors.forename: Robert
authors.initials: R
authors.lastname: Długopolski
authors.forename: Ewa
authors.initials: E
authors.lastname: Krupa
authors.forename: Romana
authors.initials: R
authors.lastname: Furtak
authors.forename: Ewa
authors.initials: E
authors.lastname: Mirek-Bryniarska
authors.forename: Marek
authors.initials: M
authors.lastname: Jastrzębski
authors.forename: Piotr
authors.initials: P
authors.lastname: Wańczura
authors.forename: Leszek
authors.initials: L
authors.lastname: Bryniarski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012189:Retrospective Studies; D018570:Risk Assessment