A Simple Clinical Model Composed of ECG, Shock Index, and Arterial Blood Gas Analysis for Predicting Severe Pulmonary Embolism

被引:14
作者
Bircan, Ahmet [1 ]
Karadeniz, Nuriye [1 ]
Ozden, Ahmet [2 ]
Cakir, Munire [1 ]
Varol, Ercan [3 ]
Oyar, Orhan [2 ]
Ozaydin, Mehmet [3 ]
机构
[1] Suleyman Demirel Univ, Dept Pulm Dis, Fac Med, TR-32260 Isparta, Turkey
[2] Suleyman Demirel Univ, Dept Radiodiagnost, Fac Med, TR-32260 Isparta, Turkey
[3] Suleyman Demirel Univ, Dept Cardiol, Fac Med, TR-32260 Isparta, Turkey
关键词
ECG; pulmonary embolism; severity; spiral thorax CT; scoring; shock index; arterial blood gas analysis; RIGHT-VENTRICULAR DYSFUNCTION; SPIRAL CT; NORMOTENSIVE PATIENTS; COMPUTED-TOMOGRAPHY; NATRIURETIC PEPTIDE; OBSTRUCTION INDEX; HELICAL CT; MANAGEMENT; DIAGNOSIS; OUTCOMES;
D O I
10.1177/1076029609351877
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Objective diagnosis of severe pulmonary embolism (PE) is obligatory because of its considerable mortality. Aim: To assess the abilities of electrocardiography (ECG) score (sECG) and the newly generated scoring system composed of the scores obtained from arterial blood gas (ABG) analysis and shock index (SI) in addition to sECG in predicting severe PE. Material and Methods: The degree of pulmonary vascular obstruction (sPVO) and the right ventricular dysfunction (RVD) were determined with spiral computed tomography (CT) in 53 consequent patients with PE. Twelve-lead ECG taken within a day of PE event and ABG values were evaluated according to ECG scoring system and original Geneva system, respectively. Results: The mean age of patients was 62.6 +/- 13.4 years. Right ventricular dysfunction, sPVO >= 50%, hypoxemia, and SI were present in 34 (64.2%), 27 (50.9%), 50 (94.3%), and 22 (41.5%) patients, respectively. The mean sECG, 5.9 +/- 5.1, was correlated with sPVO, maximum diameter of right ventricle (RV), and right ventricle to left ventricle (RV/LV) ratio (r = .385, r = .415, and r = .329, respectively). The mean newly generated score was 10.9 +/- 5.5 and correlated with sPVO, maximum diameter of RV, and RV/LV ratio (r = .394, r = .483, and r = .393, respectively). Receiver operator characteristic (ROC) curve analyses revealed that sECG >= 3.5, s (ECG + SI) >= 4.5, and s (ECG + SI + ABG) >= 9.5 predict the severe PE patients with 70.6%, 61.8%, 58.8% sensitivities and 52.6%, 63.2%, 73.7% specificities, respectively. Conclusion: Adding the scores obtained from SI and ABG to the sECG enhances the specificity of sECG in predicting RVD (+) or severe PE patients, although a lesser degree decreasing in sensitivity may occur.
引用
收藏
页码:188 / 196
页数:9
相关论文
共 49 条
[1]  
Abecasis Joao, 2008, Rev Port Cardiol, V27, P591
[2]   A POPULATION-BASED PERSPECTIVE OF THE HOSPITAL INCIDENCE AND CASE-FATALITY RATES OF DEEP-VEIN THROMBOSIS AND PULMONARY-EMBOLISM - THE WORCESTER DVT STUDY [J].
ANDERSON, FA ;
WHEELER, HB ;
GOLDBERG, RJ ;
HOSMER, DW ;
PATWARDHAN, NA ;
JOVANOVIC, B ;
FORCIER, A ;
DALEN, JE .
ARCHIVES OF INTERNAL MEDICINE, 1991, 151 (05) :933-938
[3]  
[Anonymous], 1974, JAMA-J AM MED ASSOC, V229, P1606
[4]  
[Anonymous], 1970, J AMER MED ASSOC, V214, P2163
[5]  
[Anonymous], EUR HEART J
[6]   Antithrombotic therapy for venous thromboembolic disease [J].
Büller, HR ;
Agnelli, G ;
Hull, RD ;
Hyers, TA ;
Prins, AH ;
Raskob, GE .
CHEST, 2004, 126 (03) :401S-428S
[7]   Electrocardiographic manifestations: Pulmonary embolism [J].
Chan, TC ;
Vilke, GM ;
Pollack, M ;
Brady, WJ .
JOURNAL OF EMERGENCY MEDICINE, 2001, 21 (03) :263-270
[8]   Severity assessment of acute pulmonary embolism: evaluation using helical CT [J].
Collomb, D ;
Paramelle, PJ ;
Calaque, O ;
Bosson, JL ;
Vanzetto, G ;
Barnoud, D ;
Pison, C ;
Coulomb, M ;
Ferretti, G .
EUROPEAN RADIOLOGY, 2003, 13 (07) :1508-1514
[9]   Pulmonary embolism: What have we learned since Virchow? Treatment and prevention [J].
Dalen, JE .
CHEST, 2002, 122 (05) :1801-1817
[10]   Assessment of cardiac stress from massive pulmonary embolism with 12-lead ECG [J].
Daniel, LR ;
Courtney, DM ;
Kline, JA .
CHEST, 2001, 120 (02) :474-481