12-Lead ECG Findings of Pulmonary Hypertension Occur More Frequently in Emergency Department Patients With Pulmonary Embolism Than in Patients Without Pulmonary Embolism

Michael R. Marchick, D. Mark Courtney, Christopher Kabrhel, Kristen E. Nordenholz, Michael C. Plewa, Peter B. Richman, Howard A. Smithline, Jeffrey Kline

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Study objective: Acute pulmonary embolism can produce abnormalities on ECG that reflect severity of pulmonary hypertension. Early recognition of these findings may alter the estimated pretest probability of pulmonary embolism and prompt more aggressive treatment before hemodynamic instability ensues, but it is first important to test whether these findings are specific to patients with pulmonary embolism. We hypothesize that ECG findings consistent with pulmonary hypertension would be observed more frequently in patients with pulmonary embolism. Methods: Secondary analysis of a prospective, observational cohort of emergency department patients who were tested for pulmonary embolism. ECGs were ordered at clinician's discretion and interpreted at presentation. Results: Six thousand forty-nine patients had an ECG, 354 (5.9%) of whom were diagnosed with pulmonary embolism. The frequency, positive likelihood ratio (LR+) and 95% confidence interval (CI) of each predictor were as follows: S1Q3T3 8.5% with pulmonary embolism versus 3.3% without pulmonary embolism (LR+ 3.7; 95% CI 2.5 to 5.4); nonsinus rhythm, 23.5% versus 16.6% (LR+ 1.4; 95% CI 1.2 to 1.7); inverted T waves in V1 to V2, 14.4% versus 8.1% (LR+ 1.8; 95% CI 1.3 to 2.3); inversion in V1 to V3, 10.5% versus 4.0% (LR+ 2.6; 95% CI 1.9 to 3.6); inversion in V1 to V4, 7.3% versus 2.0% (LR+ 3.7; 95% CI 2.4 to 5.5); incomplete right bundle branch block, 4.8% versus 2.8% (LR+ 1.7; 95% CI 1.0 to 2.7); tachycardia (pulse rate >100 beats/min), 28.8% versus 15.7% (LR+ 1.8; 95% CI 1.5 to 2.2). Likelihood ratios and specificities were similar when patients with previous cardiopulmonary disease were excluded from analysis. Conclusion: Findings of acute pulmonary hypertension were infrequent overall but were observed more frequently in patients with the final diagnosis of pulmonary embolism compared with patients who do not have pulmonary embolism.

Original languageEnglish (US)
Pages (from-to)331-335
Number of pages5
JournalAnnals of Emergency Medicine
Volume55
Issue number4
DOIs
StatePublished - Apr 2010
Externally publishedYes

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Pulmonary Embolism
Pulmonary Hypertension
Hospital Emergency Service
Electrocardiography
Confidence Intervals
Lead
Bundle-Branch Block
Tachycardia
Heart Rate
Hemodynamics

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

12-Lead ECG Findings of Pulmonary Hypertension Occur More Frequently in Emergency Department Patients With Pulmonary Embolism Than in Patients Without Pulmonary Embolism. / Marchick, Michael R.; Courtney, D. Mark; Kabrhel, Christopher; Nordenholz, Kristen E.; Plewa, Michael C.; Richman, Peter B.; Smithline, Howard A.; Kline, Jeffrey.

In: Annals of Emergency Medicine, Vol. 55, No. 4, 04.2010, p. 331-335.

Research output: Contribution to journalArticle

Marchick, Michael R. ; Courtney, D. Mark ; Kabrhel, Christopher ; Nordenholz, Kristen E. ; Plewa, Michael C. ; Richman, Peter B. ; Smithline, Howard A. ; Kline, Jeffrey. / 12-Lead ECG Findings of Pulmonary Hypertension Occur More Frequently in Emergency Department Patients With Pulmonary Embolism Than in Patients Without Pulmonary Embolism. In: Annals of Emergency Medicine. 2010 ; Vol. 55, No. 4. pp. 331-335.
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abstract = "Study objective: Acute pulmonary embolism can produce abnormalities on ECG that reflect severity of pulmonary hypertension. Early recognition of these findings may alter the estimated pretest probability of pulmonary embolism and prompt more aggressive treatment before hemodynamic instability ensues, but it is first important to test whether these findings are specific to patients with pulmonary embolism. We hypothesize that ECG findings consistent with pulmonary hypertension would be observed more frequently in patients with pulmonary embolism. Methods: Secondary analysis of a prospective, observational cohort of emergency department patients who were tested for pulmonary embolism. ECGs were ordered at clinician's discretion and interpreted at presentation. Results: Six thousand forty-nine patients had an ECG, 354 (5.9{\%}) of whom were diagnosed with pulmonary embolism. The frequency, positive likelihood ratio (LR+) and 95{\%} confidence interval (CI) of each predictor were as follows: S1Q3T3 8.5{\%} with pulmonary embolism versus 3.3{\%} without pulmonary embolism (LR+ 3.7; 95{\%} CI 2.5 to 5.4); nonsinus rhythm, 23.5{\%} versus 16.6{\%} (LR+ 1.4; 95{\%} CI 1.2 to 1.7); inverted T waves in V1 to V2, 14.4{\%} versus 8.1{\%} (LR+ 1.8; 95{\%} CI 1.3 to 2.3); inversion in V1 to V3, 10.5{\%} versus 4.0{\%} (LR+ 2.6; 95{\%} CI 1.9 to 3.6); inversion in V1 to V4, 7.3{\%} versus 2.0{\%} (LR+ 3.7; 95{\%} CI 2.4 to 5.5); incomplete right bundle branch block, 4.8{\%} versus 2.8{\%} (LR+ 1.7; 95{\%} CI 1.0 to 2.7); tachycardia (pulse rate >100 beats/min), 28.8{\%} versus 15.7{\%} (LR+ 1.8; 95{\%} CI 1.5 to 2.2). Likelihood ratios and specificities were similar when patients with previous cardiopulmonary disease were excluded from analysis. Conclusion: Findings of acute pulmonary hypertension were infrequent overall but were observed more frequently in patients with the final diagnosis of pulmonary embolism compared with patients who do not have pulmonary embolism.",
author = "Marchick, {Michael R.} and Courtney, {D. Mark} and Christopher Kabrhel and Nordenholz, {Kristen E.} and Plewa, {Michael C.} and Richman, {Peter B.} and Smithline, {Howard A.} and Jeffrey Kline",
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T1 - 12-Lead ECG Findings of Pulmonary Hypertension Occur More Frequently in Emergency Department Patients With Pulmonary Embolism Than in Patients Without Pulmonary Embolism

AU - Marchick, Michael R.

AU - Courtney, D. Mark

AU - Kabrhel, Christopher

AU - Nordenholz, Kristen E.

AU - Plewa, Michael C.

AU - Richman, Peter B.

AU - Smithline, Howard A.

AU - Kline, Jeffrey

PY - 2010/4

Y1 - 2010/4

N2 - Study objective: Acute pulmonary embolism can produce abnormalities on ECG that reflect severity of pulmonary hypertension. Early recognition of these findings may alter the estimated pretest probability of pulmonary embolism and prompt more aggressive treatment before hemodynamic instability ensues, but it is first important to test whether these findings are specific to patients with pulmonary embolism. We hypothesize that ECG findings consistent with pulmonary hypertension would be observed more frequently in patients with pulmonary embolism. Methods: Secondary analysis of a prospective, observational cohort of emergency department patients who were tested for pulmonary embolism. ECGs were ordered at clinician's discretion and interpreted at presentation. Results: Six thousand forty-nine patients had an ECG, 354 (5.9%) of whom were diagnosed with pulmonary embolism. The frequency, positive likelihood ratio (LR+) and 95% confidence interval (CI) of each predictor were as follows: S1Q3T3 8.5% with pulmonary embolism versus 3.3% without pulmonary embolism (LR+ 3.7; 95% CI 2.5 to 5.4); nonsinus rhythm, 23.5% versus 16.6% (LR+ 1.4; 95% CI 1.2 to 1.7); inverted T waves in V1 to V2, 14.4% versus 8.1% (LR+ 1.8; 95% CI 1.3 to 2.3); inversion in V1 to V3, 10.5% versus 4.0% (LR+ 2.6; 95% CI 1.9 to 3.6); inversion in V1 to V4, 7.3% versus 2.0% (LR+ 3.7; 95% CI 2.4 to 5.5); incomplete right bundle branch block, 4.8% versus 2.8% (LR+ 1.7; 95% CI 1.0 to 2.7); tachycardia (pulse rate >100 beats/min), 28.8% versus 15.7% (LR+ 1.8; 95% CI 1.5 to 2.2). Likelihood ratios and specificities were similar when patients with previous cardiopulmonary disease were excluded from analysis. Conclusion: Findings of acute pulmonary hypertension were infrequent overall but were observed more frequently in patients with the final diagnosis of pulmonary embolism compared with patients who do not have pulmonary embolism.

AB - Study objective: Acute pulmonary embolism can produce abnormalities on ECG that reflect severity of pulmonary hypertension. Early recognition of these findings may alter the estimated pretest probability of pulmonary embolism and prompt more aggressive treatment before hemodynamic instability ensues, but it is first important to test whether these findings are specific to patients with pulmonary embolism. We hypothesize that ECG findings consistent with pulmonary hypertension would be observed more frequently in patients with pulmonary embolism. Methods: Secondary analysis of a prospective, observational cohort of emergency department patients who were tested for pulmonary embolism. ECGs were ordered at clinician's discretion and interpreted at presentation. Results: Six thousand forty-nine patients had an ECG, 354 (5.9%) of whom were diagnosed with pulmonary embolism. The frequency, positive likelihood ratio (LR+) and 95% confidence interval (CI) of each predictor were as follows: S1Q3T3 8.5% with pulmonary embolism versus 3.3% without pulmonary embolism (LR+ 3.7; 95% CI 2.5 to 5.4); nonsinus rhythm, 23.5% versus 16.6% (LR+ 1.4; 95% CI 1.2 to 1.7); inverted T waves in V1 to V2, 14.4% versus 8.1% (LR+ 1.8; 95% CI 1.3 to 2.3); inversion in V1 to V3, 10.5% versus 4.0% (LR+ 2.6; 95% CI 1.9 to 3.6); inversion in V1 to V4, 7.3% versus 2.0% (LR+ 3.7; 95% CI 2.4 to 5.5); incomplete right bundle branch block, 4.8% versus 2.8% (LR+ 1.7; 95% CI 1.0 to 2.7); tachycardia (pulse rate >100 beats/min), 28.8% versus 15.7% (LR+ 1.8; 95% CI 1.5 to 2.2). Likelihood ratios and specificities were similar when patients with previous cardiopulmonary disease were excluded from analysis. Conclusion: Findings of acute pulmonary hypertension were infrequent overall but were observed more frequently in patients with the final diagnosis of pulmonary embolism compared with patients who do not have pulmonary embolism.

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