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

Year 2019, Volume: 41 Issue: 4, 360 - 370, 01.10.2019

Yavuz Karabağ , Tufan Çınar , Metin Çağdaş , İbrahim Rencüzoğulları

https://doi.org/10.20515/otd.440724

Abstract

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.

Keywords

R wave peak time in the lead DIII, pulmonary embolism

Akut Pulmoner Embolili Hastalarda R Dalga Pik Zamanının Tanısal Öngörücü Değeri

Abstract

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.

Keywords

R wave peak time in the lead DIII, pulmonary embolism

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