ArticleClinical research in cardiology : official journal of the German Cardiac Society2012
The role of ST-segment elevation in lead aVR in the risk assessment of patients with acute pulmonary embolism.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 25 citations in OpenAlex.
- The value of electrocardiography in prognosticating clinical deterioration and mortality in acute pulmonary embolism: A systematic review and meta-analysis.Clinical cardiology · 2017Pooled it
- Findings From 12-lead Electrocardiography That Predict Circulatory Shock From Pulmonary Embolism: Systematic Review and Meta-analysis.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2015Pooled it
- Electrocardiographic signs to differentiate between chronic thromboembolic pulmonary hypertension and intermediate-high risk acute pulmonary embolism.Scientific reports · 2026Article
- Life-threatening recurrent pulmonary embolism following anticoagulation withdrawal: a case report emphasising the management dilemma in resource-constrained settings.International journal of emergency medicine · 2025Article
- ST Elevation in aVR: An Atypical Presentation of Pulmonary Embolism.Clinical case reports · 2025Article
- Pulmonary embolism in patients with chronic coronary syndrome masquerading as acute coronary syndrome: a case report and literature review.BMC cardiovascular disorders · 2024Review
- Simultaneous ST-elevation in lead augmented vector right (aVR) and III in non-ST-elevation acute coronary syndromes.Journal of thoracic disease · 2024Article
- Article
- Algorithms of Electrocardiographic Changes for Quantitative and Localization Analysis of Thrombus Burden in Patients with Acute Pulmonary Thromboembolism.Reviews in cardiovascular medicine · 2023Article
- Electrocardiographic findings associated with early clinical deterioration in acute pulmonary embolism.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2022Article
- Clinical Significance of ST Elevation in Lead aVR in Acute Pulmonary Embolism.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2017Article
- Differential diagnostic dilemma between pulmonary embolism and acute coronary syndrome.Journal of arrhythmia · 2016Article
- Diffuse ST-Segment Depression with ST-Segment Elevation in Lead aVR in 12-Lead Electrocardiography May Indicate Ischemic Change of Severe Aortic Stenosis.Acta Cardiologica Sinica · 2015Article
- The value of electrocardiographic abnormalities in the prognosis of pulmonary embolism: a consensus paper.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2015Review
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Authors and funding
9 authors at 2 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
unlabelledBACKGROUD AND
aimPatients with acute pulmonary embolism (APE) present with highly variable symptoms and ECG abnormalities. As ST-elevation in lead aVR has recently been described to predict right ventricular dysfunction (RVD), we aimed to correlate this sign to the severity of APE.
methodsThree-hundred ninety-six consecutive patients (in centers a and b) with proven APE were retrospectively analysed with respect to 12-lead-ECG, symptoms, thrombus location, echocardiograpy, troponin T, initial therapy and outcome. Data were then compared between patients with and without aVR-ST-elevation.
resultsOn admission aVR-ST-elevation was present in 34.3% (n = 136). Presence of aVR-ST-elevation was assossiated with more severe clinical presentation (dyspnoea at rest 44.9 vs. 29.2%; p = 0.002, hypotension 17.0 vs. 6.5%; p = 0.001, syncope 16.2 vs. 6.5%; p = 0.002), higher median troponin T levels (0.035 [0.01-0.2] versus 0.01 [0.01-0.02]; p < 0.001), more frequent RVD (74.5 vs. 46.6%; p < 0.001) and central located thrombi (50.8 vs. 29.2; p < 0.001). Thrombolysis was used more frequently (29.1 vs. 7.5%; p < 0.001) and in-hospital-mortality was increased (10.3 vs. 5.4%; p = 0.07) when compared to patients without that sign. Mortality in intermediate-risk APE patients with aVR-ST-elevation was 8.9% compared to 0% in those without (p = 0.04). In contrast, the presence of other classical ECG pattern of APE did not further increase mortality in intermediate-risk patients.
conclusionsST-elevation in lead aVR is associated with a more severe course of APE, especially in patients with intermediate-risk. Therefore, aVR-ST-elevation might be useful in risk stratification of APE.
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