背景:尽管使用心电图(ECG)进行肺栓塞(PE)风险分层显示出好坏参半的结果,它目前被用作风险分层的补充证据.这项横断面研究旨在评估和比较大量和次块PE与节段性PE的ECG发现。
方法:这项横断面研究纳入了伊朗南部地区2015年至2020年确诊为急性PE的250例住院患者。人口统计变量,临床资料,肌钙蛋白水平,入院时心电图检查结果,超声心动图检查结果,接受抗凝药或溶栓剂后24小时的心电图检查结果。
结果:被诊断为亚块状或块状PE的患者表现出明显更高的右轴偏离率(p=.010),ST段异常(p<.0001),S1Q3T3模式(p<.0001),导联V1-V3中的倒T波(p<.0001),V4-V6引线中的倒T波(p<.0001),导联V1-V6中的倒T波(p<.0001)。在多变量模型中,V1-V3导联中的倒T波,V4-V6导联中的倒T波,脉冲率,和阳性肌钙蛋白测试是预测亚块状或块状PE的统计学独立变量。此外,导联V1-V3中的倒T波(灵敏度:85%,特异性:95%,准确度:93%,AUC:0.902)和肌钙蛋白水平(灵敏度:72%,特异性:86%,准确度:83%,AUC:0.792)显示了区分块状或块状PE与节段性PE的最佳诊断测试性能。
结论:除了临床规则,心电图可以作为辅助工具,用于评估PE患者的更多侵入性测试和早期积极治疗。因为它可以为亚块状或块状PE的诊断和风险分层提供有价值的信息。
BACKGROUND: Although using electrocardiogram (ECG) for pulmonary embolism (PE) risk stratification has shown mixed results, it is currently used as supplementary evidence in risk stratification. This cross-sectional study aimed to assess and compare ECG findings of massive and submassive PE versus segmental PE.
METHODS: This cross-sectional study included 250 hospitalized patients with a confirmed diagnosis of acute PE from 2015 to 2020 in Southern Iran. Demographic variables, clinical data, troponin levels, on-admission ECG findings, echocardiography findings, and ECG findings 24 h after receiving anticoagulants or thrombolytics were extracted.
RESULTS: Patients diagnosed with submassive or massive PE exhibited significantly higher rates of right axis deviation (p = .010), abnormal ST segment (p < .0001), S1Q3T3 pattern (p < .0001), inverted T wave in leads V1-V3 (p < .0001), inverted T wave in leads V4-V6 (p < .0001), and inverted T wave in leads V1-V6 (p < .0001). In a multivariable model, inverted T wave in leads V1-V3, inverted T wave in leads V4-V6, pulse rate, and positive troponin test were the statistically independent variables for predicting submassive or massive PE. Furthermore, inverted T wave in leads V1-V3 (sensitivity: 85%, specificity: 95%, accuracy: 93%, AUC: 0.902) and troponin levels (sensitivity: 72%, specificity: 86%, accuracy: 83%, AUC: 0.792) demonstrated the best diagnostic test performance for discriminating submassive or massive PE from segmental PE.
CONCLUSIONS: In addition to clinical rules, ECG can serve as an ancillary tool for assessing more invasive testing and earlier aggressive treatments among patients with PE, as it can provide valuable information for the diagnosis and risk stratification of submassive or massive PE.