title: Correlations between electrocardiogram and biomarkers in acute pulmonary embolism: Analysis of ZATPOL-2 Registry.
abstract: BACKGROUND
  Electrocardiography (ECG) is still one of the first tests performed at admission, mostly in patients (pts) with chest pain or dyspnea. The aim of this study was to assess the correlation between electrocardiographic abnormalities and cardiac biomarkers as well as echocardiographic parameter in patients with acute pulmonary embolism.
  
  
  METHODS
  We performed a retrospective analysis of 614 pts. (F/M 334/280; mean age of 67.9 ± 16.6 years) with confirmed acute pulmonary embolism (APE) who were enrolled to the ZATPOL-2 Registry between 2012 and 2014.
  
  
  RESULTS
  Elevated cardiac biomarkers were observed in 358 pts (74.4%). In this group the presence of atrial fibrillation (p = .008), right axis deviation (p = .004), S1Q3T3sign (p < .001), RBBB (p = .006), ST segment depression in leads V4-V6(p < .001), ST segment depression in lead I (p = .01), negative T waves in leads V1-V3(p < .001), negative T waves in leads V4-V6(p = .005), negative T waves in leads II, III and aVF (p = .005), ST segment elevation in lead aVR (p = .002), ST segment elevation in lead III (p = .0038) was significantly more frequent in comparison to subjects with normal serum level of cardiac biomarkers. In multivariate regression analysis, clinical predictors of "abnormal electrocardiogram" were as follows: increased heart rate (OR 1.09, 95% CI 1.02-1.17, p = .012), elevated troponin concentration (OR 3.33, 95% CI 1.94-5.72, p = .000), and right ventricular overload (OR 2.30, 95% CI 1.17-4.53, p = .016).
  
  
  CONCLUSIONS
  Electrocardiographic signs of right ventricular strain are strongly related to elevated cardiac biomarkers and echocardiographic signs of right ventricular overload. ECG may be used in preliminary risk stratification of patient with intermediate- or high-risk forms of APE.
authors.affiliation: Department of Cardiology and Internal Medicine, Specialist Hospital, Gorlice, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Kukla
authors.affiliation: Faculty of Medicine, Lazarski University, Warsaw, Poland.
authors.forename: Dariusz A
authors.initials: DA
authors.lastname: Kosior
authors.affiliation: Cardiology Department, Medical University of Lublin, Lublin, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Tomaszewski
authors.affiliation: Department of Cardiology, Medical University of Bialystok, Bialystok, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Ptaszyńska-Kopczyńska
authors.affiliation: Department of Cardiology, Health Center MCZ, Lubin, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Widejko
authors.affiliation: Department of Internal Medicine, City Hospital, Rabka-Zdrój, Poland.
authors.forename: Robert
authors.initials: R
authors.lastname: Długopolski
authors.affiliation: Independent Public Healthcare Centre Lukow, Lukow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Skrzyński
authors.affiliation: Department of Cardiology, Cardinal Wyszynski' Hospital, Lublin, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Błaszczak
authors.affiliation: Department of Statistics, Cracow University of Economics, Cracow, Poland.
authors.forename: Kamil
authors.initials: K
authors.lastname: Fijorek
authors.affiliation: Department of Pulmonary Circulation and Thromboembolic Diseases, The Medical Centre of Postgraduate Medication, European Health Centre Otwock, Otwock, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Kurzyna
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011655:Pulmonary Embolism / Q000097:blood* / Q000175:diagnosis*; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D014336:Troponin / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D014336:Troponin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: acute pulmonary embolism; cardiac biomarkers; echocardiography; electrocardiogram