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Abstract

Introduction: Pulmonary embolism (PE) is common critical care setting in daily practice. The diagnosis of acute pulmonary embolism has been challenging for the physicians. The usefulness of ECG findings for the diagnosis and as prognosticators of PE severity is still controversial.There are many studies looking at the correlation between EKG finding and found that the specific ECG abnormality might be used as initial predictor of outcome on early (30-day) mortality.However, there is a review article showed that ECG alone is of little value in the diagnosis of PE but might be helpful for ruling out other causes. This study examined whether any EKG finding are associated with severity of PE using simplified pulmonary embolism severity index (sPESI) as an outcome. Methods: In this cross-sectional study, 190 consecutive hospitalized patients with pulmonary embolism were included. Clinical data and EKG findings were collected. Simplified Pulmonary Embolism Severity Index (sPESI) was calculated. Patients were categorized by severity of pulmonary embolism defined by sPESI into low-risk and high-risk groups. Zero sPESI is considered a low-risk group Results: The cohort with mean age of 59 ± 18 years consisted of 44.2% (84 of 190) male patients. There were 116 patients (61.05%) in low-severity group. There were 112 (58.9%) normal sinus rhythm, 60 (31.6%) sinus tachycardia, 12 (6.3%) atrial fibrillation and 6 (3.2%) other EKG findings including premature ventricular contraction, premature atrial contraction and right bundle branch block. Low-severity group were younger (54 ± 17 years VS 67 ± 17 years; p<0.001), had higher prevalence of normal sinus rhythm on EKG (66.4% VS 47.3%;p=0.009) but lower prevalence of obesity (BMI>30kg/m2) (59.5% VS 43.2%;p=0.037) compared to high-severity group. Multivariable logistic regression analysis showed that normal sinus rhythm on EKG is independently associated with lower severity of pulmonary embolism after adjusted for obesity and age (Adjusted OR 0.38; 95%CI 0.2,0.74). Sensitivity and specificity of normal sinus rhythm in identifying the low risk group are 66.4% and 52.7% respectively (AUC 0.595; p0.027) Conclusions: Normal sinus rhythm is associated with the less severity of PE defined by sPESI.Sensitivity and specificity of normal sinus rhythm in identifying the low risk group are 66.4% and 52.7% respectively