P wave area for quantitative electrocardiographic assessment of left atrial remodeling Journal Article
| Authors: | Weinsaft, J. W.; Kochav, J. D.; Kim, J.; Gurevich, S.; Volo, S. C.; Afroz, A.; Petashnick, M.; Kim, A.; Devereux, R. B.; Okin, P. M. |
| Article Title: | P wave area for quantitative electrocardiographic assessment of left atrial remodeling |
| Abstract: | Background: Left atrial (LA) dilation provides a substrate for mitral regurgitation (MR) and atrial arrhythmias. ECG can screen for LA dilation but standard approaches do not assess LA geometry as a continuum, as does non-invasive imaging. This study tested ECG-quantified P wave area as an index of LA geometry. Methods and Results: 342 patients with CAD underwent ECG and CMR within 7 (0.1±1.4) days. LA area on CMR correlated best with P wave area in ECG lead V1 (r = 0.42, p<0.001), with lesser correlations for P wave amplitude and duration. P wave area increased stepwise in relation to CMR-evidenced MR severity (p<0.001), with similar results for MR on echocardiography (performed in 86% of patients). Pulmonary arterial (PA) pressure on echo was increased by 50% among patients in the highest (45±14 mmHg) vs. the lowest (31±9 mmHg) P wave area quartile of the population. In multivariate regression, CMR and echo-specific models demonstrated P wave area to be independently associated with LA size after controlling for MR, as well as echo-evidenced PA pressure. Clinical follow-up (mean 2.4±1.9 years) demonstrated ECG and CMR to yield similar results for stratification of arrhythmic risk, with a 2.6-fold increase in risk for atrial fibrillation/flutter among patients in the top P wave area quartile of the population (CI 1.1-5.9, p = 0.02), and a 3.2-fold increase among patients in the top LA area quartile (CI 1.4-7.0, p = 0.005). Conclusions: ECG-quantified P wave area provides an index of LA remodeling that parallels CMR-evidenced LA chamber geometry, and provides similar predictive value for stratification of atrial arrhythmic risk. © 2014 Weinsaft et al. |
| Journal Title: | PLoS ONE |
| Volume: | 9 |
| Issue: | 6 |
| ISSN: | 1932-6203 |
| Publisher: | Public Library of Science |
| Date Published: | 2014-06-05 |
| Start Page: | e99178 |
| Language: | English |
| DOI: | 10.1371/journal.pone.0099178 |
| PROVIDER: | scopus |
| PMCID: | PMC4047099 |
| PUBMED: | 24901435 |
| DOI/URL: | |
| Notes: | PLoS ONE -- Export Date: 8 July 2014 -- CODEN: POLNC -- Source: Scopus |
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