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ECG for risk stratification in patients with pulmonary embolism

Ramon y Cajal Hospital, Madrid, Spain

To the Editors:

We read with interest the paper by Geibel et al. 1 on the prognostic value of the ECG in patients with acute major pulmonary embolism (PE). In the last few years a number of studies have been published for risk stratification of patients with PE, with the suspicion that there could be a subgroup of haemodynamically stable patients (submassive PE), in whom thrombolysis could be beneficial 2–4.

The hypothesis of the study 1 was that ECG could be a simple baseline test (as compared with echocardiography) to identify risk of death in patients with PE. However, the population of the study included either patients with haemodynamically unstable PE, in whom thrombolysis is usually indicated, or patients with submassive PE, who are identified by echocardiographic findings. Therefore, the results may be of limited value in clinical practice.

We studied 302 consecutive normotensive patients with a diagnosis of PE in a 2-yr period. The mean age was 68 yrs (95% confidence interval (CI): 66–70) of whom 55% were female. We analysed the prognostic relevance of ECG with respect to early mortality (defined as those presented in the first 30 days). ECG was available in 278 patients, of which 116 (42%) were normal. ECG abnormalities were: 1) sinus tachycardia in 93 patients; 2) ST-T abnormalities in 29 patients; 3) complete right bundle branch block in 42 patients; 4) S1Q3T3 pattern in 32 patients; 5) atrial arrythmia in 22 patients; and 6) right axis pattern in two patients. Early death occurred in 16 patients (6%). The 12-lead ECG did not show differences between survivors and nonsurvivors during the first 30 days after admission. Univariate analysis revealed that ECG abnormalities were not significant independent predictors of outcome (odds ratio: 0.7; 95% CI: 0.2–2.5). Our results do not support the usefulness of ECG for risk stratification in haemodynamically stable patients with pulmonary embolism.

REFERENCES

1. Geibel A, Zehender M, Kasper W, Olschewski M, Klima C, Konstantinides SV. Prognostic value of the ECG on admission in patients with acute major pulmonary embolism. Eur Respir J 2005;25:843–848.[Abstract/Free Full Text]
2. Konstantinides S, Geibel A, Heusel G, et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 2002;347:1143–1150.[Abstract/Free Full Text]
3. Giannitsis E, Muller-Bardorff M, Kurowski V, et al. Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism. Circulation 2000;102:211–217.[Abstract/Free Full Text]
4. Pruszczyk P, Bochowicz A, Torbicki A, et al. Cardiac troponin T monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism. Chest 2003;123:1947–1952.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Permissions Request Permissions Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jimenez, D. Search for Related Content PubMed PubMed Citation Articles by Jimenez, D.