Characteristics of synthesized right-sided chest electrocardiograms in patients with acute pulmonary embolism. Issue 4 (April 2019)

• Record Type: Journal Article
• Authors: Kusayama, Takashi; Furusho, Hiroshi; Kinoshita, Masaki; Kaneko, Shuichi; Usuda, Kazuo; Takamura, Masayuki
• Is Part Of: Journal of cardiology. Volume 73:Issue 4(2019)
• Page Start: 313
• Page End: 317
• Publication Date: 2019-04
• Subjects: Acute pulmonary embolism -- Synthesized electrocardiography -- Right-sided chest lead -- Negative T wave; Cardiology -- Periodicals; 616.12
• DOI: 10.1016/j.jjcc.2018.12.010
• Languages: English
• ISSNs: 0914-5087

Abstract

Highlights: Detecting acute pulmonary embolism (APE) by electrocardiogram (ECG) is difficult. A standard 12-lead ECG and a synthesized right-sided chest ECG were evaluated. Traditional findings in 12-lead ECG were found in relatively few patients with APE. Syn-V3R ECG showed a higher frequency of negative T waves (66.1%) at the onset. Synthesized right-sided chest ECGs may be useful and convenient to detect APE. Abstract: Background: The significance of right-sided chest lead electrocardiogram (ECG) abnormalities in acute pulmonary embolism (APE) is unclear. This study evaluated the characteristics of such abnormalities in APE patients. Methods: This retrospective study included consecutive patients who were diagnosed with APE by contrast-enhanced computed tomography or pulmonary artery angiography. A standard 12-lead ECG and a synthesized right-sided chest ECG were obtained from these patients. Waveform differences were noted between the acute and post-treatment phases. Results: In total, 56 APE patients (18 men and 38 women, mean age 66.7 ± 13.3 years) were included. Traditional ECG findings, such as right-axis deviation, the S1 Q3 T3 pattern, and clockwise rotation, were found in relatively few patients (14.3%, 32.1%, and 21.4%, respectively). In some cases, a negative T wave in standard 12-lead ECGs was observed in leads III, V1, and V2 (46.4%, 60.7%, and 39.9%, respectively). Syn-V3R ECG showed a higher frequency of negative T waves (66.1%) at the onset and significantly ( p < 0.01) decreased at the follow-up. Multiple logistic regression analyses for differentiating APE revealed that the negative T waves only in lead syn-V3R were significantly related (odds ratio: 6.95, 95% confidence interval: 2.50–19.32, p < 0.001). Conclusions: The presence of a negative T wave in a synthesized right-sided chest ECG, particularly in the V3R lead, is a new and distinctive finding denoting pulmonary embolism. To confirm the utility of this characteristic using synthesized right-sided chest ECGs for the diagnosis of APE, further studies with larger populations will be required.