Abstract
Background
This study aimed to investigate the diagnostic value of QRS and S wave variation in
patients admitted to the emergency department with suspicion of acute pulmonary embolism
(APE).
Method
Computerized tomographic pulmonary angiography (CTPA) was performed in 118 consecutive
patients to evaluate patients with suspected APE, and 106 subjects with appropriate
electrocardiogram and CT images constituted the study population.
Results
Using CTPA, APE was diagnosed in 48.1% (n:51) of the study population. The comparison
of patients with APE and those without APE revealed that increased heart rate, right
axis deviation of QRS axis, complete or incomplete right bundle branch block, prominent
S wave in lead D1, increased QRS duration, percentage of QRS (9,8[4,8–19,0] vs 3,8[2,7–71];
p < 0,001), S wave variation (22,3[9,6–31,9] vs 4,8 [
2
,
3
,
4
,
5
,
6
,
7
,
8
]; p < 0,001) and ΔS wave amplitude (1.1[0.5–1.5] vs 0.2[0.1–0.5]; p < 0.001) were significantly associated with APE, but no relationship was detected with
respect to the presence of atrial arrhythmias, clockwise rotation of the horizontal
axis, fragmentation, ST segment deviation, T wave inversion, and S1Q3T3 and S1S2S3
patterns. The percentage of S wave variation (OR: 1072 per 1% increase, 95% CI:1011–1137)
was found to be an independent predictor of APE. ΔS wave amplitude>0.5 mm predicted APE with a sensitivity of 72.6% and a specificity of 74.6% (AUC:0.805,
95% CI: 0.717–0.876; p < 0.001).Conclusion
The present study demonstrated that QRS and S wave variation could be useful electrocardiographic
signs for the diagnosis of APE.
Keywords
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Article Info
Publication History
Published online: March 29, 2018
Accepted:
March 28,
2018
Received in revised form:
March 27,
2018
Received:
March 13,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
