title: Clinical Significance of ST Elevation in Lead aVR in Acute Pulmonary Embolism.
abstract: BACKGROUND
  Prognostic stratification of patients with acute pulmonary embolism (PTE) is crucial in identifying patients who would benefit from more aggressive treatment. We aimed to examine the value of ST elevation in lead aVR (STEaVR) in predicting hospital mortality following PTE.
  
  
  METHODS
  Two hundred patients with a diagnosis of PTE were allocated into two groups based on the presence or absence of STEaVR. Multivariate logistic regression analysis was used to investigate the role of "STEaVR" in relation to the other risk factors in predicting prognosis of PTE.
  
  
  RESULTS
  Out of 200 patients, 24 (12.0%) had STEaVR. Patients with STEaVRwere more likely to present with hypotension and tachycardia than those who did not have this electrocardiographic finding. A total of 33.3% of patients with STEaVRand 13.1% of those without STEaVRdied during hospitalization. STEaVRhad a low sensitivity of 25.8% but a high specificity of 90.5% for predicting hospital mortality. Odds ratio for hospital mortality was 3.32 for STEaVRwith 95% confidence interval of 1.28-8.64 (P = 0.017) in univariate analysis. In multivariate analysis shock was the strongest predictor of hospital mortality.
  
  
  CONCLUSIONS
  The presence of STEaVRis indicative of hemodynamic instability, thereby having the ability to predict poor outcome. However, its impact on hospital mortality disappears when the presence of shock on admission is factored in the prediction model.
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.|Anesthesiology Department, University at Buffalo, Buffalo, NY, USA.
authors.forename: Leili
authors.initials: L
authors.lastname: Pourafkari
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Samad
authors.initials: S
authors.lastname: Ghaffari
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Arezou
authors.initials: A
authors.lastname: Tajlil
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Fariborz
authors.initials: F
authors.lastname: Akbarzadeh
authors.affiliation: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Farin
authors.initials: F
authors.lastname: Jamali
authors.affiliation: Anesthesiology Department, University at Buffalo, Buffalo, NY, USA.
authors.forename: Nader D
authors.initials: ND
authors.lastname: Nader
mesh_terms: D000208:Acute Disease; D053840:Brugada Syndrome / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D000075224:Cardiac Conduction System Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004562:Electrocardiography / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity
keywords: electrocardiography; hospital mortality; pulmonary embolism