| Background:Early risk stratification of patients with acute pulmonary embolism is crucial for individualized treatment.The 2018 guidelines for the diagnosis,treatment and prevention of pulmonary thromboembolism pointed out that risk stratification of patients with pulmonary embolism is mainly based on hemodynamic status,myocardial injury markers and right ventricular function of patients.Although the electrocardiogram or the diagnosis of pulmonary embolism specificity is low,but abnormal electrocardiogram and pulmonary embolism patients prognosis is a high degree of correlation,a growing number of studies have shown that abnormal electrocardiogram is hemodynamic decompensation,right cardiac insufficiency,myocardial injury higher marks,complications,hospital reasonable predictors of death.Among them,electrocardiogram reflecting right ventricular strain has attracted much attention,and T wave inversion is one of them.However,current studies on t-wave inversion and prognosis of pulmonary embolism are usually limited to the presence or absence of t-wave inversion,but the relationship between the number of t-wave inversion leads,total amplitude and prognosis of patients with pulmonary embolism has not been further studied.There are few studies on the number and amplitude of t-wave inversion in foreign countries,and there are no domestic studies in this direction.Therefore,the prognostic value of t-wave inversion number and amplitude is not quite certain.Objective:In this paper,the sum of the lead number of t-wave inversion and the magnitude of t-wave inversion in the electrocardiogram of patients with acute pulmonary embolism were measured,and their prognostic evaluation value and risk stratification value were analyzed respectively.Methods:From January 2018 to October 2019,276 hospitalized patients with acute pulmonary embolism of CHINA-JAPAN UNION HOSPITAL OF JILIN UNIVERSITY were collected.After screening,206 patients were included in the group.The sum of the number of t-wave inversion in the electrocardiogram of each pulmonary embolism patient and the sum of the absolute magnitude of t-wave inversion were measured.According to the number of lead leads in t-wave inversion,the patients were divided into group A:TWI?4 lead(41 cases).Group B:TWI<4 lead(165 cases);The patients were divided into H group according to the sum of the absolute value of the amplitude of t-wave inversion;Group H:the amplitude absolute value>0.6mv(33 cases);Group L:the sum of amplitude absolute value<0.6mv(173 cases).Risk factors,clinical manifestations,blood biochemical indicators and prognosis(including mortality during hospitalization,occurrence of right ventricular insufficiency,need for thrombolysis,need for mechanical ventilation and need for vasoactive drugs)were compared between group A and group B.The same variables were compared between group H and group L.Finally,according to whether the patients died or not,11 patients who died were included in the case group and 195 patients who survived were included in the control group.Binary logistic regression analysis was used to analyze the correlation of independent risk factors for death in patients with acute pulmonary embolism.SPSS22.0 data analysis system was used to process data.Result:1.The incidence of t-wave inversion in pulmonary embolism was 32.1%.Dyspnea is the most common symptom of pulmonary embolism,with an incidence of 51%.2.There were no statistically significant differences in age,gender,tumor history,syncope,dyspnea,chest pain,hemoptysis,deep vein thrombosis,or recent surgery between group A(TWI?4 leads)and group B(TWI<4 leads)(P>0.05).3.Mortality?thrombolytic therapy?mechanical ventilation?vasoactive agents?elevated troponin?elevated brain natriuretic peptide?pulmonary hypertension were all statistically significant between group A(TWI?4 leads)and group B(TWI<4 leads)(P<0.05).4.Mortality?thrombolytic therapy?mechanical ventilation?vasoactive agents?elevated troponin?elevated brain natriuretic peptide?pulmonary hypertension were all statistically significant between group H and group L(P<0.05).5.Independent risk factors analysis of death in patients with acute pulmonary embolism suggested that:lead TWI?4(OR 5.407 95%ci 1.236-23.146 P=0.023),sum of TWI amplitude?0.6mv(OR 4.913 95%ci 1.140-21.177 P=0.033)and troponin positive(OR 4.329 95%ci 1.147-16.341 P=0.031)were independent risk factors for death,while other variables detected:Positive brain natriuretic peptide(OR 1.666 95%ci 0.394-7.402 P=0.487)and pulmonary hypertension(OR 1.557 95%ci 0.398-6.087 P=0.524)were not independent risk factors for death.Conclusion:1.The number of T wave inversion leads and T wave amplitude may be a useful and simple marker of increased early complications in patients with acute pulmonary embolism,and may be useful for risk stratification in patients with acute pulmonary embolism.2.TWI?4 lead,TWI amplitudes?0.6mv and troponin positive were independent risk factors for death in patients with acute pulmonary embolism. |
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