The Diagnostic Predictive Value of R wave peak time in Patients with Acute Pulmonary Embolism

Öz

This study aimed to investigate the diagnostic predictive value of R wave peak time (RWPT) in patients admitted to the emergency department with a preliminary diagnosis of acute pulmonary embolism (APE).

Computerized tomographic pulmonary angiography (CTPA) was performed in 74 consecutive patients with suspected APE, and of these 66 patients with appropriate electrocardiogram (ECG) and CTPA images composed the study population.By using CTPA, APE was confirmed in 27 patients. While the atrial arrhythmia, right axis deviation, complete or incomplete right bundle branch block, prominent S wave in the lead DI, S1Q3T3 pattern, and RWPT in the lead DIII (40±11 vs. 31±13 ms) were statistically different in patients with APE compared to those without APE (p<0.05, for all), the other ECG findings were similar. Multivariate analysis revealed that RWPT in the lead DIII (odds ratio: 14.959, 95% confidence interval: 1.811–123.582, p=0.012) was found to be an independent predictor of APE. A receiver operating characteristic analysis was drawn to show the best cut-off value of the RWPT in the lead DIII to predict APE was ≥40 ms with 48.1% sensitivity and 87.2 % specificity (area under curve (AUC): 0.718; 95% CI: 0.593–0.843; p=0.003).The present study demonstrated that the RWPT in the lead DIII may have diagnostic predictive value for APE. In addition, it may be useful in electrocardiographic signs for the diagnosis of APE.

Anahtar Kelimeler

• R wave peak time in the lead DIII,pulmonary embolism

Akut Pulmoner Embolili Hastalarda R Dalga Pik Zamanının Tanısal Öngörücü Değeri

Öz

Bu çalışmada,  akut pulmoner emboli (APE) ön tanısı ile acil servise başvuran hastalarda R dalga pik zamanın (RDPZ) tanısal değerini araştırmayı amaçladık. APE şüphesi ile ardışık 74 hastaya bilgisayarlı tomografik pulmoner anjiyografi (BTPA) uygulandı ve bu hastalardan uygun elektrokardiyografi (EKG) ve BTPA görüntüleri olan 66 hasta çalışma nüfusunu oluşturdu. BTPA kullanılarak 27 hastada APE doğrulandı. Atrial aritmi, sağ aks deviyasyonu, komple ve in komple sağ dal bloğu, DI derivasyonunda belirgin S dalgası, S1Q3T3 bulgusu ve DIII derivasyonunda RDPZ (40±11 vs. 31±13 ms) APE hastalarında istatistiksel olarak farklı iken (p<0.05, hepsi), diğer EKG bulguları benzerdi. Çoklu değişken analizi, DIII derivasyonunda ki RDPZ APE’nin bağımsız öngörücü olarak bulundu (Odd oranı: 14.959, 95% Güven Aralığı: 1.811–123.582, p=0.012). Karar vericinin etkinliği (KVE) eğrisi çizilerek RDPZ değerinin APE’nin en iyi öngörücü değeri %87,2’lük duyarlılık ve %48,1’lük bir özgüllük ile >=40 ms olarak saptandı (Eğri altında kalan alan (EAK): 0.718, 95% CI: 0.593-0.843; p=0.003). Bu çalışma DIII derivasyonunda RDPZ’nın tanısal değeri olabileceğini göstermiştir. Bunun yanında,  RDPZ’ı APE’nin tanısı için yararlı bir elektrografik bulgu olabilir.

Anahtar Kelimeler

• R wave peak time in the lead DIII,pulmonary embolism

Kaynakça

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