Abstract 9265: Differences in Negative T Waves Between Severe Acute Pulmonary Embolism and Acute Coronary Syndrome
Background: Patients with severe acute pulmonary embolism (APE) often have precordial negative T waves (NegT). However, this ECG finding is also found in acute coronary syndrome (ACS) due to the left anterior descending coronary artery (LAD) disease. Early differential diagnosis is essential to select an appropriate treatment strategy.
Methods: We studied admission ECGs in 79 patients with APE who had right ventricular dysfunction and 202 patients with ACS who were admitted within 48 h from symptom onset and had NegT in leads V1-4. Right ventricular dysfunction was defined as right ventricular dilation, paradoxical septal wall motion, or moderare/severere tricuspid regurgitation on admission echocardiography. All patients with ACS underwent coronary angiography during hospitalization, and the most severe stenosis and/or intracoronary thrombus in the LAD was confirmed.
Results: In patients with APE and ACS, at admission, systolic blood pressure was 109±27 and 151±26 mmHg (p<0.01); heart rate was 103±20 and 74±15 bpm (p<0.01); the rates of positive troponin T were 51% and 46% (p=0.36); and the amplitude of maximal NegT was 3.6±1.9 and 4.6±3.4 mm (p=0.02). The prevalence of NegT ≥1.0 mm is shown in Figure, using the anatomically contiguous Cabrera sequence to display limb leads, and it significantly differed in all leads except -aVR between 2 groups. NegT in both leads III and V1 were observed in 91% of patients with APE, as compared with only 3% of those with ACS (p<0.01). This ECG finding identified APE with 91% sensitivity, 97% specificity, and 95% predictive accuracy, which had the highest diagnostic accuracy.
Conclusions: In patients with severe APE and ACS caused by LAD disease who had precordial NegT, NegT in both leads III and V1 strongly suggests severe APE.
- © 2013 by American Heart Association, Inc.