Relationship of left atrial enlargement to persistence or development of ECG left ventricular hypertrophy in hypertensive patients: implications for the development of new atrial fibrillation

AbstractObjectivesThe goal of this study was to assess the utility of serial electrocardiograms in routine follow-up of paediatric Marfan patients.MethodsChildren ⩽18 years who met the revised Ghent criteria for Marfan syndrome and received a 12-lead electrocardiogram and echocardiogram within a 3-month period were included. Controls were matched by age, body surface area, gender, race, and ethnicity, and consisted of patients assessed in clinic with a normal cardiac evaluation. Demographic, clinical, echocardiographic, and electrocardiographic data were collected.ResultsA total of 45 Marfan patients (10.8 [2.4–17.1] years) and 37 controls (12.8 [1.3–17.1] years) were included. Left atrial enlargement and left ventricular hypertrophy were more frequently present on 12-lead electrocardiogram of Marfan patients compared with controls (12 (27%) versus 0 (0%), p<0.001; and 8 (18%) versus 0 (0%), p=0.008, respectively); however, only two patients with left atrial enlargement on 12-lead electrocardiogram were confirmed to have left atrial enlargement by echocardiogram, and one patient had mild left ventricular hypertrophy by echocardiogram, not appreciated on 12-lead electrocardiogram. QTc interval was longer in Marfan patients compared with controls (427±16 versus 417±22 ms, p=0.03), with four Marfan patients demonstrating borderline prolonged QTc intervals for gender.ConclusionsWhile Marfan patients exhibited a higher frequency of left atrial enlargement and left ventricular hypertrophy on 12-lead electrocardiograms compared with controls, these findings were not supported by echocardiography. Serial 12-lead electrocardiograms in routine follow-up of asymptomatic paediatric Marfan patients may be more appropriate for a subgroup of Marfan patients only, specifically those with prolonged QTc interval at their baseline visit.

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P313The automatically assessed P-wave axis predicts cardiovascular events in patients with cardiovascular risks: The Japan Morning Surge Home Blood Pressure (J-HOP) Study

EP Europace ◽

10.1093/europace/euaa162.099 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

T Kabutoya ◽

S Hoshide ◽

K Kario

Keyword(s):

Cardiovascular Risk ◽

Left Ventricular Hypertrophy ◽

Left Atrial ◽

Cardiovascular Events ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

P Wave ◽

Axis Deviation ◽

Left Atrial Enlargement ◽

Atrial Enlargement

Abstract Background An abnormal P-wave axis in electrocardiography predicts the development of atrial fibrillation (AF) and cardiovascular events. There have been few reports on the relationships among an automatically assessed P-wave duration, left atrial enlargement, left ventricular hypertrophy, and cardiovascular events in patients with cardiovascular risk factors. Purpose To determine the relationship among an abnormal P-wave axis, left atrial enlargement, left ventricular hypertrophy, and cardiovascular events in patients with cardiovascular risk factors. Methods We enrolled 829 subjects from the J-HOP Study who had ≥1 of four cardiovascular risk factors: hypertension, dyslipidemia, diabetes, and smoking. Twelve-lead electrocardiography was conducted, and the P-wave axis was calculated automatically using a 12-lead ECG Analysis system (Fukuda Denshi, Tokyo) according to the following formula: arctan{√3(II + III) / (2I + II-III)}. We divided the patients into three groups: those with a normal axis (0°–75°, n = 692), left axis deviation (<0°, n = 39), or right axis deviation (≥75°, n = 56). The primary endpoints were fatal/nonfatal cardiovascular events: myocardial infarction, stroke, hospitalization for heart failure, and aortic dissection. We conducted echocardiography and measured the left atrial (LA) diameter, left ventricular mass index (LVMI), and brain natriuretic peptide (BNP). Results The LA diameter, LVMI, and BNP in the patients with left axis deviation were significantly higher than those in the patients with a normal axis (LA diameter: 40.2 ± 7.0 vs. 37.0 ± 5.0, p = 0.008; LVMI: 105.7 ± 25.7 vs. 96.9 ± 25.2 g/m2, p < 0.001; median BNP: 41.6 vs. 16.5 pg/dL, p < 0.001). The mean follow-up period was 101 ± 34 months, and 92 cardiovascular events occurred. A Cox proportional hazards model including age, gender, smoking, history of hypertension, dyslipidemia, diabetes, LA dia., and LVMI revealed that left axis deviation of the P wave was independently associated with cardiovascular events (hazard ratio 2.31, 95%CI 1.18–4.55, p = 0.015). Conclusions: Leftward deviation of the automatically assessed P-wave axis was associated with left atrial enlargement, left ventricular hypertrophy, and cardiovascular events in patients with cardiovascular risk.

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