Prognostic significance of inverted T waves in patients with acute pulmonary embolism.
Prognostic significance of inverted T waves in patients with acute pulmonary embolism.
复制标题
T波倒置对急性肺栓塞患者的预后意义
作者：
M. Kosuge;K. Kimura;T. Ishikawa;T. Ebina;K. Hibi;Kengo Tsukahara;M. Kanna;N. Iwahashi;J. Okuda;N. Nozawa;H. Ozaki;H. Yano;Tatuya Nakati;I. Kusama;S. Umemura
背景
倒置T波在急性肺栓塞（PE）患者中的意义尚不清楚。
方法和结果
本文对40例急性肺栓塞患者T波倒置导联数与肺栓塞严重程度的关系进行了研究。根据入院心电图（ECG）上T波倒置的导联数将患者分为3组：15例患者，≤ 3导联（L组）; 12例患者，4-6导联（M组）; 13例患者，≥ 7导联（H组）。L、M、H组右心功能不全发生率分别为47%、92%、100%（P<0.01），院内并发症发生率（包括死亡或因血流动力学不稳定而需要儿茶酚胺支持、心肺复苏或机械心血管支持）分别为0%、8%和46%（p=0.004）。在多变量分析中，就诊时动脉低血压（OR 8.96，p=0.049）和入院时ECG ≥ 7导联T波倒置（OR 16.8，p=0.037）是院内并发症事件的唯一独立预测因素。
结论
倒置T波的导联数可能是急性PE患者早期并发症风险增加的一个有用和简单的标志。
BACKGROUND
The significance of inverted T waves remains unclear in patients with acute pulmonary embolism (PE).
METHODS AND RESULTS
The relationship of the number of leads with inverted T waves to the severity of PE in 40 patients with acute PE was studied. Patients were classified into 3 groups according to the number of leads with inverted T waves on the admission electrocardiogram (ECG): 15 patients, <or=3 leads (group L); 12 patients, 4-6 leads (group M); and 13 patients, >or=7 leads (group H). In groups L, M and H, the rates of right ventricular dysfunction on echocardiography were 47%, 92% and 100% (p<0.01), respectively, and the rates of in-hospital complicated events (including death or the need for catecholamine support, cardiopulmonary resuscitation or mechanical cardiovascular support because of hemodynamic instability) were 0%, 8% and 46% (p=0.004), respectively. On multivariate analysis, arterial hypotension at presentation (odds ratio (OR) 8.96, p=0.049) and inverted T waves in >or=7 leads on the admission ECG (OR 16.8, p=0.037) were the only independent predictors of in-hospital complicated events.
CONCLUSIONS
The number of leads with inverted T waves may be a useful and simple marker of increased risk for early complications in patients with acute PE.