The prognostic value of ECG-derived ventricular gradient in early adverse events in acute pulmonary embolism patients

• Published in: Thrombosis update Vol. 2; p. 100033
• Main Authors: Meijer, F.M.M., Hendriks, S.V., Huisman, M.V., Swenne, C.A., Kies, P., Jongbloed, M.R.M., Egorova, A.D., Vliegen, H.W., Klok, F.A.
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 2021; Elsevier
• Subjects: Diagnosis; Electrocardiogram; Pulmonary embolism; Pulmonary hypertension; Ventricular gradient; Pulmonary embolism; Diagnosis; Ventricular gradient; Electrocardiogram; Pulmonary hypertension
• ISSN: 2666-5727; 2666-5727
• DOI: 10.1016/j.tru.2021.100033

Risk-stratification in pulmonary embolism (PE) includes clinical decision rules, biomarkers and signs of right ventricular (RV) overload. The vector electrocardiogram is a diagnostic tool in which the ECG-derived ventricular gradient optimized for right ventricular pressure overload (VG-RVPO) can be used to detect patients with increased pulmonary pressure. The primary aim of this study was to assess the association of VG-RVPO and CT-assessed RV/LV diameter ratio as well as the prognostic value of an abnormal VG-RVPO for early adverse events in PE patients. In this single-center retrospective study, adult patients with acute PE were identified via the hospital’s administrative system. Adverse events were defined as the combined outcome of 30-day overall mortality, recurrent venous thromboembolism, the need for mechanical ventilation, the need for inotropic or vasopressive therapy and/or cardiac resuscitation. VG-RVPO analysis was available for 164 patients diagnosed with PE between December 2015 and September 2018. Abnormal VG-RVPO was associated with a CTPA-assessed RV/LV diameter ratio >1.0 (OR 2.0; 95%CI 1.0–3.9). The adverse 30-day composite outcome occurred in 16 of 66 patients (24%) with abnormal VG-RVPO compared to 22 of 98 patients (22%) with normal VG-RVPO (OR 1.1, 95%CI 0.53–2.3). The net reclassification improvement of VG-RVPO on top of RV dilatation for predicting early adverse events was -12%, indicating no additional prognostic value of VG-RVPO on top of RV/LV diameter ratio. Although we observed an association between RV dilatation, abnormal ECG-derived VG-RVPO was not associated with acute PE associated adverse events. •In acute pulmonary embolism the pulmonary pressure may rise and causes right ventricular dilatation.•The vector electrocardiogram can be used to detect patients with increase pulmonary pressures.•There is an association between ECG parameters and right ventricular dilatation.•The VGRVPO however was not associated with right ventricular dilatation.