Author + information
- Çağdaş Akgüllü,
- Ufuk Eryılmaz,
- Evrin Dağtekin,
- Mehmet Akdeniz,
- Hasan Güngör,
- Cemil Zencir,
- Tarkan Tekten,
- Osman Alper Onbaşılı and
- Ceyhun Ceyhan
Despite advanced therapeutic options, acute pulmonary embolism (PE) is still related to high mortality and morbidity rates. Determination of the high risk patients requiring more aggressive therapy and close monitoring remains an important issue. Acute pulmonary embolism increases the pressures of the right heart chambers and may cause various reflections that can be detected on surface electrocardiography (ECG). We aimed to demonstrate relations of QT and P wave dispersions with early death in the course of acute pulmonary embolism.
The archive data of 54 patients who had been hospitalized in our hospital with the diagnosis of PE (whom had final diagnosis after the exact demonstration of thrombus in pulmonary arteries via computed tomography) between January 2012 and April 2013 was retrospectively reviewed. 33 patients who were in sinus rhythm and whose data were suitable for QT interval and P wave analyses were included to the study. ECG's obtained within the first 12 hours of hospital admission were included in the study. Patients with atrial fibrillation during admission or excessive noises in ECG were excluded from the study. Retrospective analyses of corrected QT interval dispersions and P wave dispersions were performed for each patients. Three consecutive beats were used for the analyses where at least 10 leads were analyzable in ECGs.
Among the study population, 7 patients (%21,2) died and 26 patients (%78,8) lived after the diagnosis of PE. P wave dispersion values of deaths were significantly higher than those who survived (73 (69,5-82,5) versus 51 (39,6-57,6) respectively, p=0,000). Moreover, QTcd values of deaths were also significantly higher than the survivors (119 (103-120) versus 76 (66,5-88,5) respectively, p=0,000). There was not any significant difference between the survivors and deaths by means of age, gender, smoking habit, D-dimer levels and accompanying diseases like diabetes, hypertension, malignity, chronic obstructive pulmonary disease (COPD) and deep venous thrombosis (p>0,05). Troponin I serum levels were significantly higher in deaths (15,9±13,8 versus 2,1±10,2, p=0,01) and hemoglobin levels were significantly lower (10,6 (9-11,3) versus 12 (11-13,3), p=0,034).
To the best of our knowledge this study, for the first time demonstrated close relation of Pd with early death in the course of acute PE. In order, to detect those who were under potential high risk and who need more aggressive treatment, ECG parameters like Pd and QTcd may be used as useful markers.
|Female sex||14 (%42,4)|
|Male sex||19 (%57,6)|
|Diabetes mellitus||17 (%51,5)|
|Chronic obstructive pulmonary disease||10 (%30,3)|
|Deep venous thrombosis||5 (%15,2)|
|History of malignancy||3 (%9,1)|
|Hemodynamic Instability||27 (%81,8)|
|Total hospitalization time||8,39 (6,5-10) days|
|Hospitalization to death time||6,5 (2-10) days|
|Thrombolytic therapy||5 (%15,2)|
|Minor bleeding||4 (%12,1)|
|Major bleeding||0 (%0)|
|Troponin I||5 (0 – 1,3) mg/dl|
|QT dispersion||77 (68-94,3)|
|P wave dispersion||55,5 (41,8-63,5)|
|Longest P wave duration||104,5 (95,8-114,5)|
|Shortest P wave duration||45,5 (41,5-54,5)|
Baseline characteristics of the study population.
|Deep venous thrombosis||1 (%14,3)||4 (%15,4)||1,0|
|Diabetes mellitus||3 (%42,9)||14 (%53,8)||0,688|
|Hypertension||5 (%71,4)||18 (%69,2)||1,0|
|Chronic obstructive pulmonary disease||1 (%14,3)||9 (%34,6)||0,397|
|Malignancy||2 (%28,6)||1 (%3,8)||0,106|
|Smoking||5 (%71,4)||11 (%42,3)||0,225|
|Hemodynamic Instability||4 (%57,1)||23 (%88,5)||0,93|
|Corrected QT interval dispersion||119 (103-120)||76 (66,5-88,5)||0,000|
|P wave dispersion||73 (69,5-82,5)||51 (39,6-57,6)||0,000|
|Hemoglobin||10,6 (9-11,3)||12 (11-13,3)||0,034|
|Troponin I||17 (1,4-27)||0 (0,0-0,0)||0,01|
|D-dimer||5200 (3200-5800)||3650 (1600-5150)||0,268|
|Minor bleeding||1 (%14,3)||3 (%11,5)||1,0|
Comparison of baseline characteristics of the deaths and survivors in the course of acute pulmonary embolism.