title: The value of ECG parameters in estimating myocardial injury and establishing prognosis in patients with acute pulmonary embolism.
abstract: BACKGROUND
  The electrocardiogram (ECG) is characterised by little sensitivity and specificity in the diagnostic evaluation of acute pulmonary embolism (APE).
  
  
  OBJECTIVE
  To assess the significance of ECG changes in predicting myocardial injury and prognosis in patients with APE.
  
  
  METHODS
  The study group consisted of 225 patients (137 women and 88 men), mean age: 66.0 ± 15.2 years, in whom the diagnosis of APE was made, mostly based on computed tomography (n = 206, 92%).
  
  
  RESULTS
  We observed 26 in-hospital deaths (mortality rate: 11.5%) and complications occurred in 58 (25.7%) patients. Elevated levels of troponin were observed in 103 (46%) patients. Logistic regression analysis showed that in-hospital mortality was associated with: coronary chest pain (0.06-0.53, OR 0.18), systolic blood pressure below 100 mm Hg (2.3-13.64, OR 5.61), heart rate above 100 bpm (1.17-15.11, OR 4.21), the S1Q3T3 sign (1.31-6.99, OR 3.02), QR in V(1) (1.60-12.32, OR 4.45), ST-segment depression in V(4)-V(6) (0.99-5.40, OR 2.31), ST-segment elevation in III (0.99-6.96, OR 2.64), ST-segment elevation in V(1) (1.74-9.49, OR 4.07); borderline (1.51-16.07, OR 4.93), moderate (1.42-17.74, OR 5.01) and severe troponin elevation (2.88-36.38, OR 10.24). In patients with cTnT(+), compared to patients with normal troponin levels, the following ECG changes were significantly more common: the S1Q3T3 sign (43 vs 21%, p = 0.003), negative T waves in V(2)-V(4) (57 vs 27%, p = 0.0001), ST-segment depression in V(4)-V(6) (40 vs 14%, p = 0.001), ST-segment elevation in III (22 vs 7%, p = 0.0006), V(1) and V(2) (43 vs 10%, p = 0.0001) and QR in V(1) (16 vs 5%, p = 0.007).
  
  
  CONCLUSIONS
  ECG parameters are useful in predicting myocardial injury and assessing prognosis in 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: Krzysztof
authors.initials: K
authors.lastname: Wrabec
authors.forename: Roman
authors.initials: R
authors.lastname: Szełemej
authors.forename: Ewa
authors.initials: E
authors.lastname: Mirek-Bryniarska
authors.forename: Piotr
authors.initials: P
authors.lastname: Wańczura
authors.forename: Marek
authors.initials: M
authors.lastname: Jastrzębski
authors.forename: Leszek
authors.initials: L
authors.lastname: Bryniarski
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D004562:Electrocardiography / Q000379:methods* / Q000592:standards; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D012044:Regression Analysis; D014336:Troponin / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D014336:Troponin