The prognostic value of electrocardiography to predict inpatient mortality in patients with acute pulmonary embolism: a retrospective cohort analysis

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dc.contributor.advisorHendrikse, Clint
dc.contributor.advisorLahri, Sa'ad
dc.contributor.authorRaghubeer, Nishen
dc.date.accessioned2025-03-26T12:30:29Z
dc.date.available2025-03-26T12:30:29Z
dc.date.issued2024
dc.date.updated2025-03-26T12:24:39Z
dc.description.abstractIntroduction: Pulmonary embolism represents the third leading cause of mortality globally after myocardial infarction with an overall mortality of 30%. ECG findings may play a valuable role in the prognostication of patients with PE, with various ECG abnormalities proving to be reasonable predictors of haemodynamic decompensation, cardiogenic shock, and even mortality. This study aims to assess the prognostic value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism, as diagnosed with computed tomography pulmonary angiogram. Method: This was a retrospective cohort design study based at Tygerberg Hospital, Cape Town, South Africa. Eligible patients were identified from all CT-PA performed between 1 January 2017 and 31 December 2019. The ECGs were independently screened by two blinded emergency medicine physicians for predetermined signs that are associated with right heart strain and higher pulmonary artery pressures, and these findings were analysed to in-hospital mortality. Results: Of the included 81 patients, 61 (75%) were female. Of the 41 (51%) patients with submassive PE and 8 (10%) with massive PE, 7 (17%) and 3 (38%) suffered inpatient mortality (p=0.023) respectively. Univariate ECG analysis revealed that complete right bundle branch block (OR, 8.6; 95% CI, 1.1 to 69.9; p=0.044) and right axis deviation (OR, 5.6; 95% CI, 1.4 to 22.4; p=0.015) were significant predictors of inpatient mortality. Conclusion: Early identification of patients with pulmonary embolism at higher risk of clinical deterioration and in-patient mortality remains a challenge. Even though no clinical finding or prediction tool in isolation can reliably predict outcomes in patients with pulmonary embolism, this study demonstrated two ECG findings at presentation that were associated with a higher likelihood of inpatient mortality. This single-centre observational study with a small sample precludes concrete conclusions and a large follow-up multi-centre study is advised.
dc.identifier.apacitationRaghubeer, N. (2024). <i>The prognostic value of electrocardiography to predict inpatient mortality in patients with acute pulmonary embolism: a retrospective cohort analysis</i>. (). University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/41253en_ZA
dc.identifier.chicagocitationRaghubeer, Nishen. <i>"The prognostic value of electrocardiography to predict inpatient mortality in patients with acute pulmonary embolism: a retrospective cohort analysis."</i> ., University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2024. http://hdl.handle.net/11427/41253en_ZA
dc.identifier.citationRaghubeer, N. 2024. The prognostic value of electrocardiography to predict inpatient mortality in patients with acute pulmonary embolism: a retrospective cohort analysis. . University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. http://hdl.handle.net/11427/41253en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Raghubeer, Nishen AB - Introduction: Pulmonary embolism represents the third leading cause of mortality globally after myocardial infarction with an overall mortality of 30%. ECG findings may play a valuable role in the prognostication of patients with PE, with various ECG abnormalities proving to be reasonable predictors of haemodynamic decompensation, cardiogenic shock, and even mortality. This study aims to assess the prognostic value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism, as diagnosed with computed tomography pulmonary angiogram. Method: This was a retrospective cohort design study based at Tygerberg Hospital, Cape Town, South Africa. Eligible patients were identified from all CT-PA performed between 1 January 2017 and 31 December 2019. The ECGs were independently screened by two blinded emergency medicine physicians for predetermined signs that are associated with right heart strain and higher pulmonary artery pressures, and these findings were analysed to in-hospital mortality. Results: Of the included 81 patients, 61 (75%) were female. Of the 41 (51%) patients with submassive PE and 8 (10%) with massive PE, 7 (17%) and 3 (38%) suffered inpatient mortality (p=0.023) respectively. Univariate ECG analysis revealed that complete right bundle branch block (OR, 8.6; 95% CI, 1.1 to 69.9; p=0.044) and right axis deviation (OR, 5.6; 95% CI, 1.4 to 22.4; p=0.015) were significant predictors of inpatient mortality. Conclusion: Early identification of patients with pulmonary embolism at higher risk of clinical deterioration and in-patient mortality remains a challenge. Even though no clinical finding or prediction tool in isolation can reliably predict outcomes in patients with pulmonary embolism, this study demonstrated two ECG findings at presentation that were associated with a higher likelihood of inpatient mortality. This single-centre observational study with a small sample precludes concrete conclusions and a large follow-up multi-centre study is advised. DA - 2024 DB - OpenUCT DP - University of Cape Town KW - Emergency Medicine LK - https://open.uct.ac.za PB - University of Cape Town PY - 2024 T1 - The prognostic value of electrocardiography to predict inpatient mortality in patients with acute pulmonary embolism: a retrospective cohort analysis TI - The prognostic value of electrocardiography to predict inpatient mortality in patients with acute pulmonary embolism: a retrospective cohort analysis UR - http://hdl.handle.net/11427/41253 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/41253
dc.identifier.vancouvercitationRaghubeer N. The prognostic value of electrocardiography to predict inpatient mortality in patients with acute pulmonary embolism: a retrospective cohort analysis. []. University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2024 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/41253en_ZA
dc.language.isoen
dc.language.rfc3066Eng
dc.publisher.departmentDepartment of Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.publisher.institutionUniversity of Cape Town
dc.subjectEmergency Medicine
dc.titleThe prognostic value of electrocardiography to predict inpatient mortality in patients with acute pulmonary embolism: a retrospective cohort analysis
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMMed
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