Electrocardiographic abnormalities in patients with acute pulmonary embolism complicated by cardiogenic shock

BackgroundCardiogenic shock (CS) is a predictor of poor prognosis in patients with acute pulmonary embolism (APE).ObjectivesThe aim of this study was to compare electrocardiography (ECG) parameters in patients with APE presenting with or without CS.MethodsA 12-lead ECG was recorded on admission at a paper speed of 25 mm/s and 10 mm/mV amplification. All ECGs were examined by a single cardiologist who was blinded to all other clinical data. All ECG measurements were made manually.ResultsElectrocardiographic data from 500 patients with APE were analyzed, including 92 patients with CS. The following ECG parameters were associated with CS: S1Q3T3 sign, (odds ratio [OR]: 2.85, P < .001), qR or QR morphology of QRS in lead V1, (OR: 3.63, P < .001), right bundle branch block (RBBB) (OR: 2.46, P = .004), QRS fragmentation in lead V1 (OR: 2.94, P = .002), low QRS voltage (OR: 3.21, P < .001), negative T waves in leads V2 to V4 (OR: 1.81, P = .011), ST-segment depression in leads V4 to V6 (OR: 3.28, P < .001), ST-segment elevation in lead III (OR: 4.2, P < .001), ST-segment elevation in lead V1 (OR: 6.78, P < .01), and ST-segment elevation in lead aVR (OR: 4.35, P < .01). The multivariate analysis showed that low QRS voltage, RBBB, and ST-segment elevation in lead V1 remained statistically significant predictors of CS.ConclusionsIn patients with APE, low QRS voltage, RBBB, and ST-segment elevation in lead V1 were associated with CS.