title: Electrocardiographic abnormalities in patients with acute pulmonary embolism complicated by cardiogenic shock.
abstract: BACKGROUND
  Cardiogenic shock (CS) is a predictor of poor prognosis in patients with acute pulmonary embolism (APE).
  
  
  OBJECTIVE
  The aim of this study was to compare electrocardiography (ECG) parameters in patients with APE presenting with or without CS.
  
  
  METHODS
  A 12-lead ECG was recorded on admission at a paper speed of 25 mm/s and 10 mm/mV amplification. All ECGs were examined by a single cardiologist who was blinded to all other clinical data. All ECG measurements were made manually.
  
  
  RESULTS
  Electrocardiographic data from 500 patients with APE were analyzed, including 92 patients with CS. The following ECG parameters were associated with CS: S1Q3T3 sign, (odds ratio [OR]: 2.85, P<.001), qR or QR morphology of QRS in lead V1, (OR: 3.63, P<.001), right bundle branch block (RBBB) (OR: 2.46, P=.004), QRS fragmentation in lead V1 (OR: 2.94, P=.002), low QRS voltage (OR: 3.21, P<.001), negative T waves in leads V2 to V4 (OR: 1.81, P=.011), ST-segment depression in leads V4 to V6 (OR: 3.28, P<.001), ST-segment elevation in lead III (OR: 4.2, P<.001), ST-segment elevation in lead V1 (OR: 6.78, P<.01), and ST-segment elevation in lead aVR (OR: 4.35, P<.01). The multivariate analysis showed that low QRS voltage, RBBB, and ST-segment elevation in lead V1 remained statistically significant predictors of CS.
  
  
  CONCLUSIONS
  In patients with APE, low QRS voltage, RBBB, and ST-segment elevation in lead V1 were associated with CS.
authors.affiliation: Department of Cardiology, Specialistic Hospital, Gorlice, Poland. Electronic address: kukla_piotr@poczta.onet.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Kukla
authors.affiliation: Department of Internal Medicine, Section of Cardiology, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: William F
authors.initials: WF
authors.lastname: McIntyre
authors.affiliation: Department of Statistics, Cracow University of Economics, Cracow, Poland.
authors.forename: Kamil
authors.initials: K
authors.lastname: Fijorek
authors.affiliation: Department of Cardiology, Dietl's Hospital, Cracow, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Mirek-Bryniarska
authors.affiliation: First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Cracow, Poland.
authors.forename: Leszek
authors.initials: L
authors.lastname: Bryniarski
authors.affiliation: Department of Cardiology, Szczeklik Hospital, Tarnow, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Krupa
authors.affiliation: First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Cracow, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Jastrzębski
authors.affiliation: First Department of Internal Medicine, Dietl's Hospital, Cracow, Poland.
authors.forename: Krzysztof L
authors.initials: KL
authors.lastname: Bryniarski
authors.affiliation: Department Of Cardiology, Shiyan Taihe Hospital, Hubei University of Medicine, Hubei Province, China.
authors.forename: Zhan
authors.initials: Z
authors.lastname: Zhong-qun
authors.affiliation: Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
authors.forename: Adrian
authors.initials: A
authors.lastname: Baranchuk
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000503:physiopathology; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000150:complications* / Q000503:physiopathology; D055815:Young Adult