Utility of right-sided ECG in the diagnosis of pulmonary embolism

ABSTRACT

Background: Up to 30% of patients with pulmonary embolism (PE) were reported to have a normal 12-lead ECG. Right-sided ECG features in PE have been described in few reports and are generally a reflection of right ventricular (RV) ischemia or dilation. We believe that it would be an important tool to raise suspicion for PE in cases of normal left-sided ECG. Objective(s) Primary To determine the utility of right-sided ECG in the diagnosis of PE. Secondary To risk stratify patients whom have higher probability of PE, so that empirical treatment can be initiated while awaiting diagnostic imaging test especially in district hospitals and in times of pandemic such as COVID-19. Material(s) and Method(s) A cross-sectional study among patients in 3 hospitals were conducted from 1/6/2021 to 31/3/2022. A total of 105 patients with suspected PE were identified where simultaneous left and right-sided ECG were recorded and compared. CTPA confirmed the diagnosis of PE in 79 of them. Result(s) 75% of the cohort were diagnosed with PE. 52 of them had normal left-sided ECG, but right-sided ECG showed changes in 45 of them;namely 'R pattern' in one to three of the leads V4R, V5R and V6R (specificity 88.4%, sensitivity 50.6%) and 'Slurred S wave' in one to four of the leads V3R, V4R, V5R, V6R (specificity 84.6%, sensitivity 69.6%). 25 of patients with PE manifested RV strain pattern in both left and right-sided ECGs. There were 26 patients without PE, which served as a control group. Conclusion(s) Right-sided ECG has higher sensitivity and specificity than the standard ECG in the diagnosis of PE. Combining 'R' and 'Slurred S wave' pattern in right precordial leads increases its specificity to 100% and sensitivity to 69.6%, which highlights the importance of recording right-sided ECG along with standard ECG in patients with clinical suspicion of PE. Copyright © 2022