Evaluation Of Electrocardiographic In Adverse Clinic Outcome Of Patients With Acute Pulmonary Embolism During The Hospitalization

Objective: To assess the role of electrocardiographic in adverse outcome ofpatients with acute pulmonary embolism by analyzing the differentelectrocardiographic patterns and Daniel electrocardiographic score.Methods: We collected the data of patients who diagnosed acute pulmonaryembolism in university of Henan science and technology from January2006to June2012.525qualified patients were enrolled in our study finally. Data of baseline,symptom, electrocardiographic, clinical course, and outcome were observed during thehospitalization. The following clinical course were defined as complications:thrombolysis, treatment with catecholamine, cardiac arrest and respiratory support bymechanical ventilation. We described complications and death from all causes as theadverse clinic outcome during the hospital. Electrocardiographic characters and DanielECG score between patients with adverse and non-adverse outcome were analyzed todemonstrate if electrocardiographic was a predictor of poor prognosis in patients withacute pulmonary embolism. Chi-square, U test, multivariable logistic regression,nonparametric test and receptor operative character curve were used to analyze thedata.Results:1. There were309males and216females, the mean age was60.1±15.7years（range from14to91）. We observed108patients who developed complications duringhospitalization and60in-hospital deaths. Dyspnea （60.1%） and chest pain （45.4%）were common symptom in patients with acute pulmonary embolism. chronicpulmonary disease （64.3%）, hypertension （54.4%）, venous thromboembolism （46.4%）were observed in many patients. Sinus tachycardia （40.5%）, T wave inversion in V₁（63.5%） and V₂（30.1%） leads were common in electrocardiographic of patients withacute pulmonary embolism. 2. There were62males and46females in patients who had complications,compared with no complications patients, it was no significance in the sex （P=0.731）.The mean age in complications （64.65±14.31years） was older than no complications（58.93±15.86years）（P=0.001）. Compared with non-complicated patients, sinustachycardia （P=0.000）, clockwise rotation （P=0.003）, QR in V₁（P=0.000）, atrialarrhythmia （P=0.002）, T-wave inversion in â…¢ （P=0.01）, V₂（P=0.000） and V3（P=0.000）, S1Q3T3（P=0.021） were more common in ECG of patients withcomplicated patients. Multivariable logistic regression revealed that more than65years old （OR1.79,95%CI1.10-2.91, P=0.019）, sinus tachycardia （OR3.16,95%CI1.95-5.11, P=0.000）, T wave inversion in V3（OR2.21,95%CI1.33-3.68, P=0.002）and QR in V₁（OR3.18,95%CI1.31-7.71, P=0.011） were the significant independentpredictor of patients with complicated patients. In turn, There were36males and24females in patients who died in hospital, compared with survival patients, it was nosignificance in the sex （P=0.848）, either. Mean age in non-survival patients（66.55±15.60years） was older than survival patients （59.27±15.55years）（P=0.001）.Compared with survival patients, sinus tachycardia （P=0.000）, clockwise rotation（P=0.004）, atrial fibrillation （P=0.001）, QR in V₁（P=0.019）, complete right bundlebranch block （P=0.003） and lower limb voltage （P=0.041） were more common in ECGof patients who died in hospitalization. Multivariable logistic regression revealed thatmore than65years old （OR2.72,95%CI1.42-5.19, P=0.003）, sinus tachycardia （OR5.31,95%CI2.83-9.95, P=0.000）, complete right bundle branch block （OR3.29,95%CI1.19-9.08, P=0.021） and QR in V₁（OR=2.84,95%CI1.04-7.79, P=0.042）were the significant independent predictor of patient in death.3. The mean ECG score of4.49±4.21, median of3score, range from0to16scorein our study made the data of ECG score not a normal distribution. Daniel ECG scorewas significantly higher in patients of death （4.5,3-8） and complications （5,2-8）compared with non-death （3,1-6） and no complications （3,1-5.5）, P value was0.002and0.000, respectively. The area under receiver-operator characteristic curves inpatients of death and complication were0.624and0.646, respectively. An ECG score≥5could predict mortality and complicated in hospital course with sensitivities of50%and52%, specificities of68%and71%, positive predictive values of17%and31%,and negative predictive values of91%and85%, respectively.Conclusion: more than65years old, sinus tachycardia, QR in V₁, T wave inversion in V3, complete right bundle branch block were the independent predictor ofadverse clinic outcome in patients of acute pulmonary embolism. The Daniel ECGscore≥5could predict adverse clinic outcome of patient with acute pulmonaryembolism, but its value is limited. Nevertheless, an ECG score＜5predicts betteroutcome in these patients.