Effect of pulmonary embolism location on electrocardiological parameters

Günay, Serkan; Şancı, Emre; Sarı, Ahmet Emir; Gümüş, Semiha Aksoy; Özen, Deniz Kaptan; Halhallı, Hüseyin Cahit

doi:10.1590/1806-9282.20230733

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 69 (12) • 2023 • https://doi.org/10.1590/1806-9282.20230733 copy

Effect of pulmonary embolism location on electrocardiological parameters

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Pulmonary thromboembolism is a disease with high morbidity and mortality. Various changes occur on the electrocardiogram secondary to pulmonary thromboembolism. The objective of this study was to investigate variations in QT dispersion, Tpeak-Tend duration, and Tpeak-Tend/QT ratio in relation to pulmonary thromboembolism localization and their impacts on 30-day mortality.

METHODS:

This study was carried out in a tertiary emergency medicine clinic between December 1, 2019 and November 30, 2020. We evaluated correlations between radiological outcomes of patients, QT dispersions, T-wave dispersions, Tpeak-Tend durations, and Tpeak-Tend/QT ratios. We sought statistically significant disparities between these values, considering the presence or localization of pulmonary thromboembolism. The 30-day mortality in pulmonary thromboembolism-diagnosed patients was reassessed.

RESULTS:

Electrocardiogramfindings revealed that T-wave dispersion (p<0.001), Tpeak-Tend duration (p=0.034), and Tpeak-Tend/corrected QT ratio (p=0.003) were lower in patients than controls. Conversely, QT dispersion (p=0.005) and corrected QT dispersion (p<0.001) were higher in patients.

CONCLUSION:

Electrocardiogram findings such as T-wave dispersion, QT duration, Tpeak-Tend time, and Tpeak-Tend/corrected QT ratio can detect pulmonary thromboembolism. More studies with larger cohorts are required to further understand the role of QT and corrected QT dispersion in pulmonary thromboembolism patient mortality.

KEYWORDS:
Pulmonary embolism; Electrocardiography; Morbidity; Radiography

		Patient group (n=53)	Control group (n=54)	p-value
Sex
	Women	30 (56.60%)	26 (48.15%)	0.495⁽¹⁾ (1) Chi-square test;
	Men	23 (43.40%)	28 (51.85%)	0.495⁽¹⁾ (1) Chi-square test;
Hypertension		16 (30.19%)	20 (37.04%)	0.586⁽¹⁾ (1) Chi-square test;
Asthma/COPD		11 (20.75%)	6 (11.11%)	0.271⁽¹⁾ (1) Chi-square test;
Diabetes mellitus		7 (13.21%)	14 (25.93%)	0.158⁽¹⁾ (1) Chi-square test;
History of pulmonary embolism		9 (16.98%)	2 (3.70%)	0.052⁽¹⁾ (1) Chi-square test;
Chronic kidney disease		3 (5.66%)	3 (5.56%)	1.000⁽²⁾ (2) Fisher's exact test;
Chronic arterial disease		9 (16.98%)	15 (27.78%)	0.268⁽¹⁾ (1) Chi-square test;
Left pulmonary artery involvement		33 (62.26%)	–
	Subsegmental pulmonary artery	1 (1.89%)	–	N/A
	Segmental pulmonary artery	8 (15.09%)	–
	Lobar pulmonary artery	7 (13.21%)	–
	Main pulmonary artery	17 (32.08%)	–
Right pulmonary artery involvement		43 (81.13%)	–
	Subsegmental pulmonary artery	1 (1.89%)	–	N/A
	Segmental pulmonary artery	2 (3.77%)	–
	Lobar pulmonary artery	15 (28.30%)	–
	Main pulmonary artery	25 (47.17%)	–
Total main pulmonary artery involvement		27(50.94%)	–	N/A
Mortality		4 (7.55%)	–	N/A

		T-wave dispersion (ms)	QT wave duration (ms)	Corrected QT duration (ms)	QT dispersion (ms)	Corrected QT dispersion (ms)	Tpeak-Tend duration (ms)	Tp-e/QT ratio	Tp-e/QTc ratio
Electrocardiographic findings by groups
mean±std. deviation	Patient (n=53)	71.64±22.78	348.91±34.84	441.36±31.77	66.55±18.15	86.17±25.48	83.17±16.66	0.24±0.05	0.19±0.04
mean±std. deviation	Control (n=54)	85.31±18.54	376.24±47.24	429.52±31.64	57.70±13.52	67.15±16.92	90.85±20.02	0.24±0.05	0.21±0.04
median (min–max)	Patient (n=53)	64.7 (38.1–139.2)	348.5 (283.3–458)	441 (373–507)	62.2 (38.9–123.5)	82 (45–192)	83.3 (44.4–120.9)	0.24 (0.16–0.34)	0.19 (0.11–0.27)
median (min–max)	Control (n=54)	83.4 (50–130.3)	371.35 (272.7–483,7)	431 (368–490)	55.05 (34.1–88.4)	65 (40–115)	90.55 (51–138)	0.24 (0.12–0.39)	0.21 (0.11–0.30)
p		<0.001 ⁽²⁾ (2) Mann-Whitney U test;	0.001 ⁽¹⁾ (1) Independent samples t-test;	0.056 ⁽¹⁾ (1) Independent samples t-test;	0.005 ⁽¹⁾ (1) Independent samples t-test;	<0.001 ⁽¹⁾ (1) Independent samples t-test;	0.034 ⁽¹⁾ (1) Independent samples t-test;	0.714 ⁽¹⁾ (1) Independent samples t-test;	0.003 ⁽¹⁾ (1) Independent samples t-test;
Electrocardiographic findings according to pulmonary artery involvement
mean±std. deviation	Main pulmonary artery (n=27)	69.06±17.43	340.28±27.14	439.30±32.78	66.88±20.70	87.89±30.29	79.68±15.68	0.23±0.04	0.18±0.04
mean±std. deviation	Others (n=26)	74.33±27.36	357.87±39.94	443.50±31.18	66.22±15.48	84.38±19.75	86.80±17.17	0.24±0.05	0.20±0.04
Median (min–max)	Main pulmonary artery (n=27)	64.7 (44.5–106,6)	340 (283.3–391.8)	437 (377–507)	60.9 (40.9–123.5)	80 (52–192)	80 (44.4–111.7)	0.24 (0.16–0.32)	0.19 (0.11–0.25)
Median (min–max)	Others (n=26)	69.8 (38.1–139.2)	360.9 (295–458)	445 (373–504)	64.9 (38.9–103.4)	84.5 (45–123)	88.15 (50–120.9)	0.24 (0.16–0.34)	0.20 (0.13–0.27)
p		0.669 ⁽²⁾ (2) Mann-Whitney U test;	0.066 ⁽¹⁾ (1) Independent samples t-test;	0.635 ⁽¹⁾ (1) Independent samples t-test;	0.896 ⁽¹⁾ (1) Independent samples t-test;	0.621 ⁽¹⁾ (1) Independent samples t-test;	0.121 ⁽¹⁾ (1) Independent samples t-test;	0.413 ⁽¹⁾ (1) Independent samples t-test;	0.177 ⁽¹⁾ (1) Independent samples t-test;
Electrocardiographic findings according to the presence of mortality
mean±std. deviation	Mortality (no) (n=49)	72.20±23.56	349.02±34.86	440.00±29.83	65.73±16.67	84.98±24.37	82.62±15.85	0.24±0.04	0.19±0.04
mean±std. deviation	Mortality (yes) (n=4)	64.78±6.77	347.63±39.92	458.00±53.37	76.70±33.42	100.75±38.09	89.95±26.97	0.26±0.07	0.19±0.04
Median (min–max)	Mortality (no) (n=49)	64.8 (38.1–139.2)	343.5 (283.3–458)	438 (373–507)	62.2 (38.9–123.5)	82 (45–192)	83.3 (44.4–111.7)	0.23 (0.16–0.34)	0.19 (0.11–0.27)
Median (min–max)	Mortality (yes) (n=4)	62.6 (59.4–74.5)	364.35 (288.8–373)	469.5 (389–504)	67.75 (48.7–122.6)	95.5 (63–149)	89.75 (59.4–120.9)	0.27 (0.17–0.33)	0.20 (0.13–0.24)
p⁽²⁾ (2) Mann-Whitney U test;		0.661	0.833	0.369	0.661	0.444	0.615	0.405	0.569

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[1] *Corresponding author: drsrkngny@gmail.com