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European Heart Journal 2003 24(12):1113-1119; doi:10.1016/S0195-668X(03)00132-5
Copyright © 2003 by the European Society of Cardiology.
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QR in V1 – an ECG sign associated with right ventricular strain and adverse clinical outcome in pulmonary embolism

Nils Kucher*, Nazan Walpoth, Kerstin Wustmann, Markus Noveanu and Marc Gertsch

Cardiology, Swiss Cardiovascular Center Bern, University Hospital, 3010 Bern, Switzerland

* Corresponding author: Nils Kucher, MD, Cardiology, Harvard Medical School, Brigham and Women‘s Hospital, VTE Research Group, 75 Francis Street, Boston, MA 02115, USA. Tel.: +1-617-732-6986; fax: +1-617-738-7652
E-mail address: nkucher{at}freesurf.ch

Received 11 October 2002; revised 26 November 2002; accepted 27 November 2002

Aims To test the hypothesis that Qr in V1is a predictor of pulmonary embolism, right ventricular strain, and adverse clinical outcome.

Methods and Results ECG’s from 151 patients with suspected pulmonary embolism were blindly interpreted by two observers. Echocardiography, troponin I, and pro-brain natriuretic peptide levels were obtained in 75 patients with pulmonary embolism. Qr in V1(14 vs 0 in controls; p<0.0001) and ST elevation in V1≥1mV (15 vs 1 in controls; p=0.0002) were more frequently present in patients with pulmonary embolism. Sensitivity and specificity of Qr in V1and T wave inversion in V2for predicting right ventricular dysfunction were 31/97% and 45/94%, respectively. Three of five patients who died in-hospital and 11 of 20 patients with a complicated course, presented with Qr in V1. After adjustment for right ventricular strain including ECG, echocardiography, pro-brain natriuretic peptide and troponin I levels, Qr in V1(OR 8.7, 95%CI 1.4–56.7; p=0.02) remained an independent predictor of adverse outcome.

Conclusions Among the ECG signs seen in patients with acute pulmonary embolism, Qr in V1is closely related to the presence of right ventricular dysfunction, and is an independent predictor of adverse clinical outcome.

Key Words: Echocardiography • electrocardiography • pulmonary embolism


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