The value of the right precordial electrocardiogram in acute pulmonary embolism

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.