Korean J Intern Med.  2012 Mar;27(1):53-59. 10.3904/kjim.2012.27.1.53.

Normalization of Negative T-Wave on Electrocardiography and Right Ventricular Dysfunction in Patients with an Acute Pulmonary Embolism

• Choi BY
• Park DG

• KMID: 1776566
• DOI: http://doi.org/10.3904/kjim.2012.27.1.53

Abstract

BACKGROUND/AIMS
Right ventricular dysfunction (RVD) is associated with poor prognosis in patients with acute pulmonary embolism (APE). Echocardiography and computed tomography (CT)-angiography may be difficult to perform in a serial follow up, unlike electrocardiography (ECG). Many ECG findings specific for APE have been reported, and many studies have found that negative T-waves (NTW) in precordial leads are most frequently observed in patients with APE. We analyzed serial changes in precordial NTW to detect RVD and predict the recovery of RVD in patients with APE.
METHODS
We examined 81 consecutive patients diagnosed with APE using CT-angiography or echocardiography. ECG, transthoracic echocardiography, and laboratory tests were performed within 24 hours of admission, and daily ECG follow-up was performed. Precordial NTWs were defined by the new development of pointed and symmetrical inverted T-waves in at least three leads. Recovery of NTW was defined as flattening or upright inverted T-waves in more than two leads.
RESULTS
Of the 81 patients with APE, 52 (64%) had RVD according to echocardiography. Among the patients with RVD, 33 (63%) showed precordial NTW. The multivariate logistic regression analysis revealed that NTW was the strongest independent predictor for RVD (odds ratio, 22.8; 95% confidence interval, 2.4 to 221.4; p = 0.007). Time to normalization of NTW was associated with improvement of RVD on echocardiography (r = 0.84, p < 0.01).
CONCLUSIONS
Precordial NTW was a reliable finding to identify RVD in patients with APE. Improvements in RVD can be predicted by normalizing precordial NTW.

Keyword

Pulmonary embolism; Ventricular dysfunction, right; Electrocardiography

MeSH Terms

Acute Disease
Aged
Aged, 80 and over
Chi-Square Distribution
Echocardiography
*Electrocardiography
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Predictive Value of Tests
Prognosis
Pulmonary Embolism/complications/*diagnosis
Recovery of Function
Republic of Korea
Time Factors
Tomography, X-Ray Computed
Ventricular Dysfunction, Right/complications/*diagnosis/physiopathology
*Ventricular Function, Right