Relationship between P Wave Dispersion and Left Ventricular Diastolic Dysfunction in Hypertensive and Ischemic Heart Disease Patients

2015 ◽  
Vol 8 (1) ◽  
pp. 13-18
Author(s):  
Asif Zaman Tushar ◽  
AAS Majumder ◽  
STM Abu Azam ◽  
Mohammad Ullah ◽  
Rashid Ahmed ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Wave Dispersion ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
P Wave ◽  
P Wave Dispersion ◽  
Wave Duration ◽  
P Wave Duration ◽  
Ventricular Diastolic Dysfunction ◽  
Surface Electrocardiogram

Background: There is growing recognition that congestive heart failure caused by a predominant abnormality in left ventricular diastolic function is common and causes significant morbidity and mortality. Diastolic function usually declines before systolic function, and this precedes clinical signs. 12-lead electrocardiogram is a commonly used tool to assess left atrial enlargement, which is a marker of left ventricular diastolic dysfunction. We investigated the relationship between P wave dispersion, which is easily measured on the surface electrocardiogram and left ventricular diastolic function.Methods: There were 100 patients: 50 with diastolic dysfunction and 50 without. P wave dispersions were calculated by measuring minimum and maximum P wave duration values on the surface electrocardiogram. The relationships between P wave dispersion and echocardiographic measurements of diastolic dysfunction were assessed.Results: Maximum P wave duration was observed significantly (p=0.001) in patients with left ventricular diastolic dysfunction (119.60±8.2 ms vs 114.0±6.4 ms). Minimum P wave duration was observed significantly (p=0.001) higher in patients without diastolic dysfunction (72.6±7.5 ms vs 62.70±7.4 ms). P wave dispersion was observed significantly (p=0.001) higher in patients with left ventricular diastolic dysfunction (56.6±6.3 ms vs 41.5±5.2 ms). When patients were grouped according to grades of diastolic dysfunction, P wave dispersion was observed sequentially increased among 3 grades of left ventricular diastolic dysfunction (55.8±5.2 ms vs 55.9±7.0 ms vs 61.4±4.7) but the differences were not statistically significant (p=0.09).Conclusion: We conclude that P wave dispersion increases in diastolic dysfunction of LV. When clinical and echocardiographic variables are taken into account, there is a weak but significant correlation between P wave dispersion and left ventricular ejection fraction.Cardiovasc. j. 2015; 8(1): 13-18

scholarly journals P-Wave Duration and Dispersion in Patients with Mitral Stenosis

2021 ◽  
Author(s):  
Wenxia Fu ◽  
Jiawei Le ◽  
Xijin Wei ◽  
lixiu chen ◽  
Wenzhao Li ◽  
...  
Keyword(s):  
Mitral Stenosis ◽  
Test Group ◽  
Wave Dispersion ◽  
Left Ventricular ◽  
P Wave ◽  
Control Group ◽  
P Wave Dispersion ◽  
Wave Duration ◽  
P Wave Duration ◽  
Increased Risk

Abstract Background: Mitral stenosis (MS) is related to prolonged inter- and intra-atrial electromechanical delays and increased P-wave dispersion. The objective of the current study was to investigate the correlation between the P-wave duration, P-wave dispersion (PWD), mitral stenosis (MS) and to explore the cut-off values for predicting the MS in the patients.Methods: We enrolled 62 patients with MS and sinus rhythm as test group, and 62 healthy subjects matched in age- and sex- were selected as control group. We conducted the 12-lead electrocardiogram and echocardiography for all the subjects. The maximum and the minimum P-wave duration and PWD were calculated. Univariate and multivariate logistic regression analyses were performed to demonstrate the correlation between P-wave duration and PWD and MS. The receiver operating characteristic (ROC) curve was drawn to detect the threshold of P-wave duration and PWD for predicting the MS.Results: There were significant differences in the left atrial diameter (45.00±5.78 vs. 32.31±4.24 cm2), pulmonary artery pressure (46.68±17.29 vs. 32.64±2.86 mm Hg), left ventricular end-diastolic diameter (47.57±4.80 vs. 45.58±5.04 cm), ejection fraction (63.10±3.05 vs. 65.13±2.56%), aortic root inside diameter (29.60±3.50 vs. 31.58±3.58) and pulmonary trunk (24.17±2.78 vs. 22.23±1.77) values between the test group and the control group. Besides, the test subjects had significantly longer maximum P-wave duration (123.42±12.33 vs. 108.18±9.07) and larger P-wave dispersion (47.24±13.61 vs. 28.94±9.19). In the multivariate analysis, maximum P-wave duration (OR:1.221, 95% CI:1.126-1.324) and P-wave dispersion (OR:1.164, 95% CI:1.094-1.238) were correlated with the occurrence of MS. The optimal threshold for the maximum P-wave duration and PWD were 119.50ms, and 42.50ms, respectively, and the areas under the curve were 0.859 and 0.865, respectively. Conclusions: A longer P-wave duration and a higher PWD are correlated with the increased risk of MS progression.

scholarly journals Evaluation of left atrial mechanics and p-wave dispersion as markers of left atrial cardiopathy in patients of embolic stroke of undetermined source (ESUS)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Masood ◽  
M.M Azharuddin ◽  
S.M.K Ashraf ◽  
S Wahab
Keyword(s):  
Left Atrial ◽  
Wave Dispersion ◽  
Embolic Stroke ◽  
P Wave ◽  
Electromechanical Delay ◽  
P Wave Dispersion ◽  
Atrial Electromechanical Delay ◽  
Wave Duration ◽  
P Wave Duration ◽  
Increased Risk

Abstract Introduction Around 25% of all ischaemic strokes have no known cause despite standard investigations. Most of these cases are suspected to have an embolic source for ischaemia, leading to the moniker of Embolic Stroke of Undetermined Source (ESUS). Recent studies suggest that abnormalities of the left atrium, in the form of atrial cardiopathy, can lead to increased risk of stroke even in the absence of atrial fibrillation (AF), which may be either as precursors to AF or as independent risk factors for the development of left atrial thrombus and subsequent stroke. Purpose The aim of this study was to measure LA electromechanical dissociation, LA volumes and P-wave dispersion as markers of atrial cardiopathy in patients with ESUS to determine whether atrial cardiopathy may be in the causal pathway of ESUS. Methods 28 patients presenting with ischaemic stroke and fulfilling the criteria for ESUS were enrolled into this cross-sectional, observational study. All patients had 24-hour Holter monitoring done to rule out the presence of AF. The control group consisted of 28 age- and gender-matched apparently healthy individuals. On ECG, P-wave Dispersion (PWD) was calculated by subtracting minimum P-wave duration from maximum P-wave duration. On echocardiography, time intervals from the beginning of P-wave to beginning of A' wave from the lateral mitral annulus in tissue doppler imaging was measured as the atrial electromechanical delay. LA volumes were recorded using the Modified Biplane Simpson's method. Statistical analysis was performed using student's t-test, chi-square test, and Pearson's test. Results Baseline demographic and laboratory characteristics were similar between the two groups. Increased PWD (34.14±9.89 ms vs. 27.32±8.95 ms; p=0.01), atrial electromechanical delay (73.32±16.31 ms vs. 63.63±13.59 ms; p=0.02) and LA volumes were observed in patients with ESUS as compared to controls. A significant correlation was also found between these parameters (p<0.01). Discussion According to the results of our study, PWD, atrial electromechanical delay and LA volumes may be novel predictors for ESUS. Atrial cardiopathy is a unique mechanism of thrombo-embolism in ESUS patients and our data establishes its association with ESUS. Further studies will be needed to shed more light on its role in the causality of stroke in the ESUS population. Measurement of electromechanical delay Funding Acknowledgement Type of funding source: None

scholarly journals Correlation between P-Wave Terminal Force V1 (PTFV1) from 12-Lead ECG and Left Ventricular Diastolic Dysfunction in Patients Diagnosed With Hypertension

2020 ◽  
Vol 6 (2) ◽  
pp. 97-103
Author(s):  
Bambang Arie Hidayat Dalimunthe ◽  
Nizam Akbar ◽  
Refli Hasan ◽  
Harris Hasan ◽  
Andika Sitepu ◽  
...  
Keyword(s):  
Diastolic Dysfunction ◽  
Systolic Dysfunction ◽  
Hypertensive Heart Disease ◽  
Left Ventricular Diastolic Dysfunction ◽  
Left Ventricular ◽  
P Wave ◽  
P Value ◽  
Cross Sectional ◽  
Ventricular Diastolic Dysfunction ◽  
Grade Iii

Background: Patients diagnosed with hypertension will deteriorate into hypertensive heart disease which is characterized by diastolic dysfunction first followed by systolic dysfunction later in the course of the disease. Diastolic dysfunction of the left ventricle causes an increase in LVEDP as well as in the dimension of the left atrium. P-Wave Terminal Force V1 (PTFV1) which is derived from 12 lead ECG could help diagnose diastolic dysfunction in centers where echocardiography is not available. The purpose of this study was to determine the correlation of PTFV1 on the 12-lead Electrocardiography with diastolic dysfunction in patients diagnosed with hypertension in the outpatient clinic of Cardiac Center Adam Malik General Hospital in Medan. Methods: This is a cross-sectional study conducted from March 2019 until August 2019. Patients with hypertension who met the inclusion criteria were examined electrocardiographically to obtain PTFV1 value. Then echocardiography examination was then performed to assess the grades of diastolic dysfunction and other parameters. Analysis of correlation between PTFV1 values and diastolic dysfunction was then conducted. Results: From the clinical characteristics, there is no difference regarding age, sex , and risk factorsbetween the three diastolic dysfunction groups, while echocardiography characteristic shows more reduced EF in grade III diastolic dysfunction (36.5±7.7). Significant differences in PTFV1 are found among diastolic dysfunction groups. Grade I diastolic dysfunction has PTFV1 value of 23.8 mm.ms, grade II diastolic dysfunction has PTFV1 value of 34.1 mm.ms, and grade III diastolic dysfunction has PTFV1 value of 52.1 mm.ms, Significance of  p value is <0.001. There is a strong correlation between PTFV1 and diastolic dysfunction grade (r = 0.63 (P <0.001)). Cut off point of PTFV1 > 29.8 mm.ms can discriminate patients who have increased LAP with a sensitivity of 84% and specificity of 71%. Conclusions: PTFV1 is a simple screening tool which is widely available and correlate well with left ventricular diastolic dysfunction in patients with hypertension, which makes it a good alternative tool especially in areas where echocardiography is not readily available.

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