Swave resolution in standard electrocardiography aVL lead in 48 hours from admission of severe acute pulmonary embolism is associated to favorable outcome in various subgroups of patients

Abstract Background An electrocardiography record does not serve for the diagnosis of pulmonary embolism. Still, it can indirectly, accurately, and without delay display acute right ventricle overload which represents the main feature of the severe disease. The aim of this study is to investigate the association of a single ECG sign change, the resolution of S wave in aVL lead with the outcome of severe PE patients. Methods Data from this investigation are gained from the Regional PE Registry (REPER) with prospectively variable definition and collection. Among 1814 patients with acute PE, 212 intermediate-high and high-risk PE patients had recorded S wave in aVL and if there was a resolution of this sign in the 48 hours from the admission to the hospital. Of the 145 (68.4%) were treated with thrombolytic therapy. Association between S wave in aVL resolution and all-cause hospital mortality in various subgroups of patients was estimated with Cox regression and Kaplan-Meier’s (KM) curves. Results S wave resolution in aVL in 48 h was recorded in 135 (63.7%) patients. Patients treated with thrombolysis had a higher frequency of S wave resolution compared to those treated with anticoagulant therapy only (76.3% vs 54.5%, p=0.01). The in-hospital mortality rate was significantly lower in patients with S wave resolution regardless of the patient sex (1.4% vs 25.8%, p<0.001 in men, and 6.1% vs 34.8% in women) age (1.1% vs 31.0%, p<0.01 in patients<70 y, and 9.1% vs 31.4%, p<0.01 in patients≥70y), thrombolytic therapy (2.9% vs 26.2%, p<0.01 in patients treated with thrombolysis, and 6.2% vs 37.1%, p<0.01 in patients who did not), duration of symptoms (3.0% vs 44%, p<0.01 in patients with symptoms less than 24 hours, and 4.4% vs 25%, p<0.01 in patients who had symptoms more than 24 hours before admission) and risk (3.2% vs 18%, p<0.01 in intermediate-high risk PE, and 4.9% vs 55.6%, p<0.01 in high-risk PE). KM Log Rank p for hospital survival regarding S wave aVL resolution was 0.003 for patients who did not treated with thrombolysis, and <0.001 in patients treated with thrombolysis (figure 1 and 2). Conclusion S wave resolution in aVL in the 48 h of acute intermediate-high and high-risk PE patients is an excellent sign of improvement of right ventricle function, and it is associated with better outcomes whenever patients are treated or not with thrombolysis, or if they belong to high-risk or intermediate-high risk subgroup.KM S wave resolution and NO thrombolysisKM S wave resolution and thrombolysis