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Prediction of right ventricular dysfunction in patients with pulmonary embolism
Critical Care volume 9, Article number: P17 (2005)
Right ventricular dysfunction (RVD) is associated with adverse events in patients with pulmonary embolism (PE). An early diagnosis of RVD is thus necessary and may lead to a more aggressive approach. We investigated clinical, electrocardiographic and chest X-ray variables in patients with confirmed pulmonary embolism and proposed a model for prediction of RVD.
A multicenter cohort included 625 patients, from January 1998 to May 2003, admitted with diagnosis of pulmonary embolism confirmed by: pulmonary angiography, helical computer tomography, magnetic resonance, echocardiography or lung scan. From 550 patients who had a 2D echocardiogram, 191 (34%) met RVD criteria (ventricular dilatation or hypokinesia). We investigated 28 clinical (risk factors, signs and symptoms), electrocardiographic and chest X-ray findings in those patients for correlation with RVD. After univariate analysis, we selected variables (P < 0.20) for logistic regression. C-statistics were determined and the independent variables were applied for building a model for RVD prediction.
In univariate analysis, gender, recent surgery (<30 days), chronic cor pulmonale, chest pain, tachycardia (>100 beats/min), syncope, tachypnea (>20 breaths/min), arterial hypotension (systolic BP <90 mmHg), cyanosis, right axis deviation, S1Q3T3 pattern, right bundle block (RBB) and T-wave inversion (V1–V4 leads) were selected for multivariate analysis. In logistic regression, recent surgery (OR = 0.37, P = 0.004), tachypnea (OR = 1.89, P = 0.001), hypotension (OR = 2.00, P = 0.002), S1Q3T3 pattern (OR = 3.33, P < 0.001), RBB (OR = 2.22, P < 0.001) and T-wave inversion (V1–V4 leads) (OR = 2.80, P < 0.01) were independent variables for prediction of RVD. The C-statistic was 0.71 and the resulting model presented a linear trend (P < 0.01).
In this proposed model, simple bedside information such as recent surgery, tachypnea, hypotension, S1Q3T3 pattern, RBB and T-wave inversion can be used to predict RVD in patients with PE in clinical practice.
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Volschan, A., Knibel, M., Sousa, P. et al. Prediction of right ventricular dysfunction in patients with pulmonary embolism. Crit Care 9 (Suppl 2), P17 (2005). https://doi.org/10.1186/cc3561
- Pulmonary Embolism
- Ventricular Dysfunction
- Right Ventricular Dysfunction
- Pulmonary Angiography
- Axis Deviation