著者
Masami Kosuge Toshiaki Ebina Kiyoshi Hibi Kengo Tsukahara Noriaki Iwahashi Satoshi Umemura Kazuo Kimura
出版者
日本循環器学会
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
pp.CJ-13-1064, (Released:2013-12-03)
参考文献数
24
被引用文献数
3 16

Background: Patients with acute pulmonary embolism (APE) often have negative T waves (Neg T) in precordial leads at presentation, but this is also found in acute coronary syndrome (ACS) caused by left anterior descending coronary artery (LAD) disease. Methods and Results: Differences in Neg T on admission electrocardiograms were studied between 107 patients with APE and 248 patients with ACS caused by LAD disease. All patients had Neg T in leads V1–4 and were admitted within 7 days from symptom onset. The number of leads with Neg T (4.8±1.8 vs. 5.5±1.7, P<0.001) and maximum magnitude of Neg T (3.4±2.0 vs. 4.7±3.3mm, P<0.001) were lower in APE. The frequency of occurrence of Neg T in each of the 12 leads, and the precordial lead with the greatest Neg T (peak Neg T) differed between APE and ACS (all P<0.05, respectively). APE was strongly associated with the presence of Neg T in both leads III and V1 and peak Neg T in leads V1–2. The combination of these 2 findings identified APE with 98% sensitivity, 92% specificity, and 94% predictive accuracy, which represented the highest diagnostic accuracy. Conclusions: Among patients with APE and ACS who have precordial Neg T, the presence of Neg T in leads III and V1 and/or peak Neg T in leads V1–2 simply but accurately differentiates APE from ACS.

言及状況

外部データベース (DOI)

Twitter (12 users, 16 posts, 33 favorites)

@EcgsOnly The perfect reference material to solve this incredible ECG! https://t.co/19NoOsrLob
Vía @DidlakeDW : https://t.co/qnblTUGJDj https://t.co/NmHunjzpp2 https://t.co/LTcAKVY1G5
@sdSuhailDar @EcgsOnly @EcgOxford @ecgrhythms @PMcardioBot @Dr_Ahmedkanani @smithECGBlog @DrDeepakKrishn1 @OSEM_Conference @RobertHermanMD Per Kosuge the distribution and magnitude of T wave inversion favors a reperfusing LAD > PE. Apically directed injury vector. https://t.co/19NoOsrLob
@marioalrb84_a @The_Nanashi_O @ecgrhythms @EM_RESUS @smithECGBlog @OrlandoRPN @angna_86 @cardiogax @y_interna @DanielSierraLM @cardioelihu @BrooksWalsh @relm_11969 @RobertHermanMD Acute RV strain (most nefarious cause being PE). Kosuge is very helpful in these circumstances. https://t.co/19NoOsrLob
@ECGfan @ShariqShamimMD @EM_RESUS @smithECGBlog @iamritu @DrMarthaGulati @mmamas1973 @evandrofilhobr @AnastasiaSMihai @DrQuinnCapers4 @MKIttlesonMD https://t.co/nlvES45tqs
@anunay_cardio @DrRajeshG1 This is a great case, sir. Thanks for sharing! If captured *during symptoms* then the pattern fits the Kosuge criteria for PE over ACS. Perhaps an #echofirst would help speed refinement of the DDx. https://t.co/19NoOsrLob
@bougiemedic @EcgsOnly @ecgrhythms Kosuge studied this very dilemma of T wave configuration when the DDx is Wellens vs PE. A worthwhile read
@thebyrdlab Not my favourite or anything, but I've only stumbled upon it a couple of weeks ago, so I'm sharing it enthusiastically: Differenciating acute coronary syndromes from pulmonary embolisms by negative T-Waves. https://t.co/Rjj3YesECp

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