title: The role of ST-segment elevation in lead aVR in the risk assessment of patients with acute pulmonary embolism.
abstract: BACKGROUD AND AIM:                          Patients with acute pulmonary embolism (APE) present with highly variable symptoms and ECG abnormalities. As ST-elevation in lead aVR has recently been described to predict right ventricular dysfunction (RVD), we aimed to correlate this sign to the severity of APE.
  
  
  METHODS
  Three-hundred ninety-six consecutive patients (in centers a and b) with proven APE were retrospectively analysed with respect to 12-lead-ECG, symptoms, thrombus location, echocardiograpy, troponin T, initial therapy and outcome. Data were then compared between patients with and without aVR-ST-elevation.
  
  
  RESULTS
  On admission aVR-ST-elevation was present in 34.3% (n = 136). Presence of aVR-ST-elevation was assossiated with more severe clinical presentation (dyspnoea at rest 44.9 vs. 29.2%; p = 0.002, hypotension 17.0 vs. 6.5%; p = 0.001, syncope 16.2 vs. 6.5%; p = 0.002), higher median troponin T levels (0.035 [0.01-0.2] versus 0.01 [0.01-0.02]; p < 0.001), more frequent RVD (74.5 vs. 46.6%; p < 0.001) and central located thrombi (50.8 vs. 29.2; p < 0.001). Thrombolysis was used more frequently (29.1 vs. 7.5%; p < 0.001) and in-hospital-mortality was increased (10.3 vs. 5.4%; p = 0.07) when compared to patients without that sign. Mortality in intermediate-risk APE patients with aVR-ST-elevation was 8.9% compared to 0% in those without (p = 0.04). In contrast, the presence of other classical ECG pattern of APE did not further increase mortality in intermediate-risk patients.
  
  
  CONCLUSIONS
  ST-elevation in lead aVR is associated with a more severe course of APE, especially in patients with intermediate-risk. Therefore, aVR-ST-elevation might be useful in risk stratification of APE.
authors.affiliation: Department of Emergency Medicine, University of Medicine, Vienna, Austria.
authors.forename: Karin
authors.initials: K
authors.lastname: Janata
authors.forename: Thomas
authors.initials: T
authors.lastname: Höchtl
authors.forename: Catharina
authors.initials: C
authors.lastname: Wenzel
authors.forename: Rudolf
authors.initials: R
authors.lastname: Jarai
authors.forename: Barbara
authors.initials: B
authors.lastname: Fellner
authors.forename: Alexander
authors.initials: A
authors.lastname: Geppert
authors.forename: Peter
authors.initials: P
authors.lastname: Smetana
authors.forename: Vera
authors.initials: V
authors.lastname: Havranek
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020107:Troponin T / Q000097:blood*; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000175:diagnosis*
chemical_list: D020107:Troponin T