ELECTROCARDIOGRAPHIC CHANGES IN ACUTE PULMONARY EMBOLISM WITH RIGHT HEART STRAIN AND IT'S ASSOCIATION WITH ADVERSE CLINICAL EVENTS

Abstract

Objective: To determine the frequency of electrocardiographic changes in right heart strain RHS due to acute pulmonary embolism PE and its effect on mortality.

Study Design: Prospective cross-sectional study.

Place and Duration of Study: AFIC/NIHD Rawalpindi, from Dec 2015 to Jan 2018.

Material and Methods: 70 patients with acute pulmonary embolism were enrolled in this study. The primary outcome was right heart strain (RHS) on echocardiogram. The secondary outcome was mortality.

Results: Mean age was 50.16 ± 18.754 and male were 51 (72.9%). Thirty eight (54.28%) had right heart strain RHS on echocardiography. Mortality was 14 (20%). Provocating factors were identified in 34 (48.6%). Major contributing factors were high altitude in 11 (15.7%) and postoperative and malignancy cases in 7 (10%) each. ECG changes with significant association with RHS included: Tachycadia in 13 (34%) (p-value 0.013), S wave in
lead I in 12 (31.57%) (p-value 0.039), T wave inversion TWI in lead VI and lead V2 in 10 (26.31%) and TWI in lead VI to V3 in 8 (21.05%) (p-value 0.03). ECG changes with significant association with mortality included- Tachycardia ≥100 bpmin 7 (50%) (p-value 0.012), SIQ3T3 in 5 (35.71%) (p-value 0.022), S wave in lead I in 8 (57.14%) (p-value 0.001), TWI in leads V1 through V2 in 5 (35.71%) (p-value 0.054) and TWI in leads V1 through
V3 in 5 (35.71%) (p-value 0.013).

Conclusions: ECG can identify patients with RHS in acute PE and this in turn helps in identifying patients vulnerable to adverse clinical events.