Correlation between atrial electrocardiographic indexes and left atrial enlargement in competitive athletes. From the ALMUDAINA case-control study

Abstract Background Left atrial (LA) remodelling and enlargement in athletes is a well-kown component of the athlete's heart. However, information about the correlation between of LA enlargement and atrial electrophysiological features in athletes is scarce. Purpose Our aim was to characterize LA enlargement, P-wave duration, and the prevalence of interatrial block (IAB) in competitive athletes (with and without LA enlargement) and in controls. Methods ALMUDAINA (Analysis of Left atrial Measurements of Ultrasound Dilation Among International and National Athletes) was a nationwide, cross-sectional study involving 9 hospitals and sport clinics across Spain. Cases fulfilled the international consensus definition of a competitive athlete and were currently engaged in skill, power, mixed or endurance disciplines at a national or international level. The following P-wave parameters were analysed: 1) duration 2) voltage in lead I and 3) the presence of interatrial block (IAB). LA enlargement was defined as an indexed volume by body surface area ≥34 ml/m2, measured by transthoracic echocardiography. A contemporary cohort of otherwise healthy and active controls was used as a comparison group. Results Baseline clinical and echocardiographic characteristics of both cohorts are summarised in table 1 whereas electrocardiographic characteristics are displayed in table 2, respectively. 356 subjects were included, 308 athletes (mean age: 36.4±11.6 years) and 48 controls (mean age: 49.3±16.1 years). Athletes showed a higher mean LA indexed volume (29.8±8.6 vs. 25.6±8.0 mL/m2, P=0.006) and higher prevalence of LA enlargement (113 [36.7%] vs. 5 [10.4%], P<0.001), but there were no relevant differences in P-wave duration (106.3±12.5 ms vs 108.2±7.7 ms; P=0.31), voltage in lead I (0.08±0.04 vs. 0.08±0,04 mV; P=0.79) and the prevalence of IAB (40 [13.0%] vs. 4 [8.3%], P=0.36). Only a case of advance IAB was detected, in an athlete without LA enlargement. Among athletes, those with LA enlargement (113, 36.7%) had higher P-wave duration (110.3±14.1 vs. 103.0±10.9 ms, P<0.001) and a higher prevalence of interatrial blockade (23 [20.4%] vs. 17 [8.8%], P=0.004), but similar voltage of P-wave in lead I (0.08±0.003 vs. 0.08±0.05 mV, P=0.689). In a multivariate analysis, competitive training was independently associated with LA enlargement (odds ratio [OR] 14.7, 95% confidence interval [CI] 4.7–44.0; P<0.001) but was not associated with P-wave duration (OR 1.02, 95% CI: 0.99–1.04; P=0.19) or IAB (OR 1.4, 95% CI 0.7–3.1; P=0.34). Conclusions LA enlargement is prevalent in adult competitive athletes. However, ECG indexes of atrial electrophysiology were not different from healthy controls. Our data suggest that LA enlargement and IAB are two different entities. FUNDunding Acknowledgement Type of funding sources: None.

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Correlation of Left Atrial Size With P-Wave Duration in Interatrial Block

CHEST Journal ◽

10.1378/chest.128.4.2615 ◽

2005 ◽

Vol 128 (4) ◽

pp. 2615-2618 ◽

Cited By ~ 46

Author(s):

Vignendra Ariyarajah ◽

Kristin Mercado ◽

Sirin Apiyasawat ◽

Puneet Puri ◽

David H Spodick

Keyword(s):

Left Atrial ◽

P Wave ◽

Left Atrial Size ◽

Wave Duration ◽

P Wave Duration ◽

Atrial Size ◽

Interatrial Block

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Independent associations of blood pressure and body mass index with interatrial block: a cross-sectional study in general Chinese population

BMJ Open ◽

10.1136/bmjopen-2019-029463 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029463 ◽

Cited By ~ 3

Author(s):

Guozhe Sun ◽

Ying Zhou ◽

Ning Ye ◽

Shaojun Wu ◽

Yingxian Sun

Keyword(s):

Blood Pressure ◽

Chinese Population ◽

Cross Sectional Study ◽

P Wave ◽

Regression Analyses ◽

Sectional Study ◽

Cross Sectional ◽

Wave Duration ◽

P Wave Duration ◽

General Chinese Population

ObjectivesThis current study was performed to characterise the independent associations of obesity and hypertension with interatrial block (IAB) after adjusting for cardiovascular risk factors, echocardiographic left atrial diameter (LAD) and left ventricular mass index (LVMI) in a large general Chinese population.DesignA cross-sectional study.Setting and participantsA total of 11 956 permanent residents (≥35 years of age) from Liaoning Province in China were included in this study. Following the completion of a questionnaire, the enrolled participants were subjected to physical examinations, laboratory analyses, ECG and echocardiogram. Linear and logistic regression analyses were performed to evaluate the associations of hypertension and obesity with IAB.Outcome measuresIAB was defined as a prolongation of the P wave duration ≥120 ms on a digital 12-lead ECG.ResultsThe prevalence of IAB in hypertensive individuals was higher than the normotensive in both men (9.5 vs 5.9%; p<0.001) and women (6.6 vs 3.6%; p<0.001). In addition, the prevalence of IAB exhibited a sharp increase with advancing body mass index (BMI) in both men (from 4.9% to 13.0%) and women (from 3.5% to 6.9%) (ps- for trend <0.001). Multiple relevant clinical covariates, echocardiographic LAD and LVMI were adjusted in the multivariate linear and logistic regression analyses. The results revealed that systolic blood pressure, diastolic blood pressure and BMI were all independently associated with P wave duration (β=0.02, 0.09 and 0.25, respectively; all ps <0.005). Furthermore, hypertension was found to be independently associated with IAB (OR=1.27; p=0.018), while both overweight and obesity exhibited higher odds of IAB (OR=1.42 and 1.67, respectively; ps <0.005), compared with BMI <24.0 kg/m2.ConclusionsThe key findings of this study highlighted that hypertension and overweight/obesity were independently and significantly associated with IAB in general Chinese population.

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Advanced interatrial block precedes atrial fibrillation and stroke. The prospective interatrial Block And Yearly EventS (BAYES) registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.0485 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Martinez-Selles ◽

R Elosua ◽

M Ibarrola ◽

M De Andres ◽

P Diez-Villanueva ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Disease ◽

Sinus Rhythm ◽

Structural Heart Disease ◽

P Wave ◽

Wave Duration ◽

P Wave Duration ◽

Previous Diagnosis ◽

Surface Ecg ◽

Interatrial Block

Abstract Background Advanced interatrial block (IAB), prolonged and bimodal P waves in surface ECG inferior leads, is an unrecognized surrogate of atrial dysfunction and a trigger of atrial dysrhythmias, mainly atrial fibrillation (AF). Our aim was to prospectively assess whether advanced IAB in sinus rhythm precedes AF and stroke in elderly outpatients with structural heart disease, a group not previously studied. Methods Prospective observational registry that included outpatients aged ≥70 years with structural heart disease and no previous diagnosis of AF. Patients were divided into three groups according to P-wave characteristics. Results Among 556 individuals, 223 had normal P-wave (40.1%), 196 partial IAB (35.3%), and 137 advanced IAB (24.6%). After a median follow-up of 694 days; 93 patients (16.7%) developed AF, 30 stroke (5.4%), and 34 died (6.1%). Advanced IAB was independently associated with AF (hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.7–5.1, p<0.001), stroke (HR 3.8, 95% CI 1.4–10.7, p=0.010), and AF/stroke (HR 2.6, 95% CI 1.5–4.4, p=0.001). P-wave duration (ms) was independently associated with AF (HR 1.05, 95% CI 1.03–1.07, p<0.001), AF/stroke (HR 1.04, 95% CI 1.02–1.06, p<0.001), and mortality (HR 1.04, 95% CI 1.00–1.08, p=0.021). Conclusions The presence of advanced IAB in sinus rhythm is a risk factor for AF and stroke in an elderly population with structural heart disease and no previous diagnosis of AF. P-wave duration was also associated with all-cause mortality. Figure. Age- and sex-adjusted linear and non-linear association between P-wave duration (msec) and atrial fibrillation (A), stroke (B), and atrial fibrillation or stroke (C) risk. Results of a generalized additive model with spline smoothing functions and 4 degrees of freedom. Figure 1. Kaplan-Meyer curves of survival free of atrial fibrillation (A), stroke (B) and atrial fibrillation or stroke (C) in patients with normal P-wave, partial interatrial block (IAB) and advanced IAB. Funding Acknowledgement Type of funding source: None

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

European Heart Journal ◽

10.1093/ehjci/ehaa946.2437 ◽

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

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A specific combination of P wave duration and morphology accurately predicts the presence of left atrial low voltage area in patients with atrial fibrillation

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2019.10.002 ◽

2020 ◽

Vol 63 ◽

pp. 173-180 ◽

Cited By ~ 2

Author(s):

Tatsuhiko Ooie ◽

Osamu Wakisaka ◽

Takashi Hujita ◽

Youta Urakabe ◽

Masayuki Kaneko ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Low Voltage ◽

P Wave ◽

Specific Combination ◽

Wave Duration ◽

P Wave Duration

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The impact of left atrial pressure on filtered P-wave duration in patients with atrial fibrillation

Heart and Vessels ◽

10.1007/s00380-015-0789-3 ◽

2016 ◽

Vol 31 (11) ◽

pp. 1848-1854 ◽

Cited By ~ 12

Author(s):

Hideyuki Kishima ◽

Takanao Mine ◽

Satoshi Takahashi ◽

Kenki Ashida ◽

Masaharu Ishihara ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

P Wave ◽

Atrial Pressure ◽

Left Atrial Pressure ◽

Wave Duration ◽

P Wave Duration ◽

The Impact

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Contribution of Left Atrial Pressure and Dimension to Signal-Averaged P-Wave Duration in Patients With Chronic Congestive Heart Failure

The American Journal of Cardiology ◽

10.1016/s0002-9149(96)00720-5 ◽

1997 ◽

Vol 79 (2) ◽

pp. 219-222 ◽

Cited By ~ 35

Author(s):

Pompilio Faggiano ◽

Antonio D'Aloia ◽

Emanuela Zanelli ◽

Anna Gualeni ◽

Paola Musatti ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Left Atrial ◽

P Wave ◽

Atrial Pressure ◽

Left Atrial Pressure ◽

Chronic Congestive Heart Failure ◽

Wave Duration ◽

P Wave Duration

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Baseline ECG and Prognosis After Transcatheter Aortic Valve Implantation: The Role of Interatrial Block

Journal of the American Heart Association ◽

10.1161/jaha.120.017624 ◽

2020 ◽

Vol 9 (22) ◽

Author(s):

Lourdes Vicent ◽

Clara Fernández‐Cordón ◽

Luis Nombela‐Franco ◽

Luis Alberto Escobar‐Robledo ◽

Ana Ayesta ◽

...

Keyword(s):

Atrial Fibrillation ◽

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

P Wave ◽

Wave Duration ◽

Transcatheter Aortic Valve ◽

P Wave Duration ◽

Aortic Valve Implantation ◽

Interatrial Block ◽

Valve Implantation

Background The clinical significance of conduction disturbances after transcatheter aortic valve implantation has been described; however, little is known about the influence of baseline ECGs in the prognosis of these patients. Our aim was to study the influence of baseline ECG parameters, including interatrial block (IAB), in the prognosis of patients treated with transcatheter aortic valve implantation. Methods and Results The BIT (Baseline Interatrial Block and Transcatheter Aortic Valve Implantation) registry included 2527 patients with aortic stenosis treated with transcatheter aortic valve implantation. A centralized analysis of baseline ECGs was performed. Patients were divided into 4 groups: normal P wave duration (<120 ms); partial IAB (P wave duration ≥120 ms, positive in the inferior leads); advanced IAB (P wave duration ≥120 ms, biphasic [+/–] morphology in the inferior leads); and nonsinus rhythm (atrial fibrillation/flutter and paced rhythm). The mean age of patients was 82.6±9.8 years and 1397 (55.3%) were women. A total of 960 patients (38.0%) had a normal P wave, 582 (23.0%) had partial IAB, 300 (11.9%) had advanced IAB, and 685 (27.1%) presented with nonsinus rhythm. Mean follow‐up duration was 465±171 days. Advanced IAB was the only independent predictor of all‐cause mortality (hazard ratio [HR], 1.48; 95% CI, 1.10–1.98 [ P =0.010]) and of the composite end point (death/stroke/new atrial fibrillation) (HR, 1.51; 95% CI, 1.17–1.94 [ P =0.001]). Conclusions Baseline ECG characteristics influence the prognosis of patients with aortic stenosis treated with transcatheter aortic valve implantation. Advanced IAB is present in about an eighth of patients and is associated with all‐cause death and the composite end point of death, stroke, and new atrial fibrillation during follow‐up.

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Cachexia is associated with depression, anxiety and quality of life in cancer patients

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2019-002176 ◽

2020 ◽

pp. bmjspcare-2019-002176

Author(s):

Huihui Sun ◽

Thapa Sudip ◽

Xiaofen Fu ◽

Su Wen ◽

Huiquan Liu ◽

...

Keyword(s):

Quality Of Life ◽

Negative Relationship ◽

Severe Depression ◽

Cross Sectional Study ◽

Life Questionnaire ◽

International Consensus ◽

Consensus Definition ◽

Cross Sectional ◽

Patients With Cancer

ObjectivesThis study aimed to compare depression, anxiety and quality of life (QoL) between cachexia and non-cachexia patients, and explore the relationship between cachexia and depression, anxiety and QoL in patients with cancer.MethodsA total of 528 patients from cancer centres of four hospitals were enrolled in this cross-sectional study. All patients were divided into cachexia and non-cachexia according to international consensus definition of cachexia. Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and Quality of Life Questionnaire-Cancer 30 (QLQ-C30) were used to evaluate depression, anxiety and QoL.Results285 patients (53.98%) were classified as cachexia. The prevalence of depression, anxiety, severe depression and severe anxiety in cachexia was 30.2%, 18.6%, 6.7% and 8.4%, respectively, which were significantly higher than in non-cachexia (all p<0.01). Patients with cachexia obviously acquired poorer physical function (PF), role function (RF), cognitive function (CF), emotional function (EF), social function (SF) and overall QoL than non-cachexia patients (all p<0.01). Cachexia was positively associated with depression (unstandardised coefficient (B)=2.123, p<0.001) and anxiety (B=1.123, p=0.024), and had a negative relationship with PF, CF, EF, SF and overall QoL (all B<0, all p<0.05).ConclusionsCachexia was associated with greater depression and anxiety and poorer QoL in patients with cancer, which emphasised the importance of timely identification and management of cachexia to improve the psychological problems and QoL among patients with cancer.

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