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ECG Score Predicts Those With the Greatest Percentage of Perfusion Defects Due to Acute Pulmonary Thromboembolic Disease

      Background

      More aggressive management may be warranted for patients with acute pulmonary embolism (PE) and the greatest pulmonary vascular obstruction. We hypothesized that a scoring system based on the ECG might identify such patients.

      Methods

      Consecutive patients investigated for PE at Christchurch Hospital between 1997 and 2002 with high-probability ventilation/perfusion (/) scan findings were studied. The ECG obtained closest to and within 48 h of the scan was scored by two independent observers, and the mean ECG score was calculated. / scan findings were categorized into those with < 30%, 30 to 50%, and > 50% perfusion defect by two independent observers experienced in / interpretation. A consensus score was taken when disagreement occurred.

      Results

      Two hundred twenty-nine patients were included in the study. The interobserver agreement for ECG score was 0.96 (Cronbach α) and / score was 0.55 (κ). The ECG predicted those with the greatest amount of perfusion defects. Mean ECG score was 2.6 (SD 2.8) in patients with < 30% perfusion defect, 3.2 (SD 2.9) in patients with 30 to 50% perfusion defect, and 5.3 (SD 3.7) in patients with > 50% perfusion defect. The area under the receiver operating characteristic curve for ECG score and those with > 50% perfusion defect was 0.71 (SE 0.04). An ECG score of ≥ 3 predicted those with > 50% perfusion defect with a sensitivity of 70% (95% confidence interval [CI], 59 to 81%), and a specificity of 59% (95% CI, 51 to 67%).

      Conclusion

      An ECG score, simple to derive, predicts those with the greatest percentage of perfusion defect. Using the ECG for management warrants prospective evaluation.

      Key words

      Abbreviations:

      ANOVA (analysis of variance), CI (confidence interval), PE (pulmonary embolism), ROC (receiver operating characteristic), / (ventilation/perfusion)
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      References

        • 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
        • Yacovella T
        • Alter M
        Anticoagulation for venous thromboembolism: what are the current options?.
        Postgrad Med. 2000; 108 (51–54): 43-46
        • Daniel KR
        • Courtney DM
        • Kline JA
        Assessment of cardiac stress from massive pulmonary embolism with 12-lead ECG.
        Chest. 2001; 120: 474-481
        • Burkill GJ
        • Bell JR
        • Padley SP
        Survey on the use of pulmonary scintigraphy, spiral CT and conventional pulmonary angiography for suspected pulmonary embolism in the British Isles.
        Clin Radiol. 1999; 54: 807-810
        • Galle C
        • Papazyan JP
        • Miron MJ
        • et al.
        Prediction of pulmonary embolism extent by clinical findings, d-dimer level and deep vein thrombosis shown by ultrasound.
        Thromb Haemost. 2001; 86: 1156-1160
      1. British Thoracic Society guidelines for the management of suspected acute pulmonary embolism.
        Thorax. 2003; 58: 470-483
        • The PIOPED Investigators
        Value of the ventilation/perfusion scan in acute pulmonary embolism: results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED).
        JAMA. 1990; 263: 2753-2759
        • Janata K
        • Holzer M
        • Laggner AN
        • et al.
        Cardiac troponin T in the severity assessment of patients with pulmonary embolism: cohort study.
        BMJ. 2003; 326: 312-313
        • Ribeiro A
        • Lindmarker P
        • Juhlin-Dannfelt A
        • et al.
        Echocardiography Doppler in pulmonary embolism: right ventricular dysfunction as a predictor of mortality rate.
        Am Heart J. 1997; 134: 479-487
        • Rodger M
        • Makropoulos D
        • Turek M
        • et al.
        Diagnostic value of the electrocardiogram in suspected pulmonary embolism.
        Am J Cardiol. 2000; 86 (A810): 807-809
        • Stein PD
        • Dalen JE
        • McIntyre KM
        • et al.
        The electrocardiogram in acute pulmonary embolism.
        Prog Cardiovasc Dis. 1975; 17: 247-257
        • Ferrari E
        • Imbert A
        • Chevalier T
        • et al.
        The ECG in pulmonary embolism: predictive value of negative T waves in precordial leads; 80 case reports.
        Chest. 1997; 111: 537-543