The value of the right precordial electrocardiogram in acute pulmonary embolism

Jason M. Lazar, R. Smith, M. Grudman, M. Adler, E. Yung, A. Fein, L. Heller, S. Zeldis, R. Steingart

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The purpose of this study was to determine the value of the the right precordial electrocardiogram (RPECG) in the setting of acute PE. Methods: We prospectively studied pts clinically suspected of PE referred for V/Q scanning and/or pulmonary angiography. RPECGs were obtained within 2 hours of studies in all pts. ST-T changes were assessed in leads RV3-V5. For each lead, sensitivity (sens), specificity (spec), positive and negative predictive values were calculated (PPV,NPV). Results: 6 pts had normal and 18 had low probability (prob) V/Q scans. 15 pts had high prob scans. Exclusion of pts with indeterminate scans left 18 males/21 females, age 65±17 yrs. The results are below. Lead Sens Spec PPV NPV RV4 ST 53% 66% 50% 70% RV4 T 73% 66% 58% 73% RV5 ST 60% 74% 60% 74% RV5 T 73% 57% 52% 76% Conclusions: RPECG ST-T changes are more common in pts with a greater likelihood of PE. The NPV of ST-T changes were greater than sens, spec, and PPV. Clinical Implications: While ST-T changes in individual RPECG leads are of limited value, combination of ECG criteria may improve diagnostic yield and make the RPECG a useful and inexpensive diagnostic aid in suspected acute PE.

Original languageEnglish
Pages (from-to)219S
JournalChest
Volume110
Issue number4 SUPPL.
StatePublished - Oct 1996
Externally publishedYes

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