T-wave inversion in patients with acute pulmonary embolism: Prognostic value

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T-wave inversion (TWI) is a common ECG finding in patients with acute pulmonary embolism (APE).


To determine the prevalence of TWI in patients with APE and to describe their relationship to outcomes.


Retrospective study of 437 patients with APE. TWI patterns were described in two distributions: inferior (II, III, aVF) and precordial (V1-V6).


TWI was observed in 258 (59%) patients. The mortality rate was significantly higher in the group with TWI in the inferior AND precordial leads compared to the group without TWI (OR: 2.74; p = 0.024) and the group with TWI in the inferior OR precordial leads (OR: 2.43; p = 0.035). As compared those with TWI in <5 leads, patients with TWI in ≥5 leads experienced significantly higher rates of death (17.1% vs. 6.6%, OR: 2.92; p = 0.002) and complications.


TWI and the quantitative assessment thereof can be useful to risk stratify patients with APE.

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