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ECG Score of Daniel et al for Cardiac Stress After Massive Pulmonary Embolism

Purpose: To evaluate a patient with a pulmonary embolus using the ECG score of Daniel et al.

Description

Daniel et al developed a score based on changes in the 12-lead electrocardiogram (ECG) for evaluating a patient with a pulmonary embolus causing pulmonary hypertension. This can help distinguish patients with massive embolism resulting in severe pulmonary hypertension from those with less severe disease. The authors are from Oklahoma State University in Tulsa and Carolinas Medical Center in Charlotte, North Carolina.


Parameters:

(1) heart rate

(2) right bundle branch block

(3) T wave inversion

(4) SI QIII TIII (S wave in lead I, Q wave in lead III, inverted T wave in lead III)

 

Parameter

Finding

Points

heart rate

tachycardia (> 100 beats/min)

2

 

<= 100 beats per minute

0

right bundle branch block

none

0

 

incomplete

2

 

complete

3

T wave inversion

in leads V1 through V4 (all)

4

 

else

0

T wave inversion in lead V1

none or < 1 mm

0

 

1 – 2 mm

1

 

> 2 mm

2

T wave inversion in lead V2

none

0

 

> 0 and < 1 mm

1

 

1 – 2 mm

2

 

> 2 mm

3

T wave inversion in lead V3

none

0

 

> 0 and < 1 mm

1

 

1 – 2 mm

2

 

> 2 mm

3

S wave in lead I

yes

0

 

no

0

Q wave in lead III

yes

1

 

no

0

inverted T wave in lead III

yes

1

 

no

0

SI QIII TIII all present

yes

2

 

no

0

 

total score =

= SUM(points for all of the measures)

 

Interpretation:

• minimum score: 0

• maximum score: 21

• The higher the pulmonary artery pressure the higher the score.

• A score >= 10 was 23.5% sensitive and 97.7% specific for recognition of severe pulmonary hypertension (pulmonary artery pressure > 50 mm Hg) following pulmonary embolus.

• The range of scores for patients with a fatal PE was 4.3 to 14.7 (mean 9.5).

 

Performance:

• The interobserver agreement good (Spearman r value 0.74).

• Area under the ROC curve was 62 +/- 12% (Figure 4, page 479).


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Specialty

Objective

ICD-10