Prognostic significance of P‐wave morphology in patients with coronary artery disease

Numerous studies have demonstrated the negative prognostic value of tachycardia, both in the general population and in specific subgroups, including patients with coronary artery disease (CAD), arterial hypertension (HTN) and heart failure with preserved ejection fraction (HFpEF). In the latest edition of the European guidlines for the treatment of HTN the level of heart rate (HR) exceeding 80 beats per minute is highlighted as a separate independent predictor of adverse outcomes. However, the feasibility of pharmacological reduction of HR in patients with sinus rhythm is unclear. Unlike patients with reduced ejection fraction, in whom the positive effects of HR reduction are well established, the data on the effect of pharmacological HR reduction on the prognosis of patients with HTN, CAD and/or HFpEF are not so unambiguous. Some adverse effects of pharmacological correction of HR in such patients, which may be caused by a change in the aortic pressure waveform with its increase in late systole in the presence of left ventricular diastolic dysfunction, are discussed. The reviewed data underline the complexity of the problem of clinical and prognostic significance of increased HR and its correction in patients with HTN, stable CAD and/or HFpEF.

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Reduced P-wave Voltage in Lead I is Associated with Development of Atrial Fibrillation in Patients with Coronary Artery Disease

Journal of Atrial Fibrillation ◽

10.4022/jafib.1657 ◽

2017 ◽

Vol 10 (4) ◽

Cited By ~ 9

Author(s):

Adrian Baranchuk

Keyword(s):

Atrial Fibrillation ◽

Coronary Artery Disease ◽

Coronary Artery ◽

P Wave ◽

Artery Disease

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Abstract 15487: Combined Effects of Lipoprotein(a) and Hypertension in Predicting Cardiovascular Outcomes in Patients With Coronary Artery Disease

Circulation ◽

10.1161/circ.142.suppl_3.15487 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Huihui Liu ◽

Yexuan Cao ◽

Jinglu Jin ◽

Hui-Wen Zhang ◽

Qi Hua ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Cox Regression ◽

Reference Group ◽

Prognostic Significance ◽

Cardiovascular Death ◽

Hypertension Status ◽

Clinical Prognosis ◽

Lipoprotein A ◽

Artery Disease

Introduction: Although emerging data have suggested that circulating lipoprotein(a) [Lp(a)] could predict cardiovascular events (CVEs) in patients with cardiovascular disease, no study is currently available regarding the prognostic significance of Lp(a) in patients with hypertension. Hypothesis: We assessed the hypothesis that there is a prognostic linkage between hypertension and Lp(a) concentrations in patients with coronary artery disease (CAD). Methods: A total of 8668 patients with stable CAD were consecutively enrolled. Baseline Lp(a) concentrations of them were measured. All subjects were categorized according to Lp(a) levels of <10 (low), 10-30 (medium) and 30 mg/dL (high) and were further stratified by hypertension status. They were regularly followed-up for the occurrence of cardiovascular death, non-fatal myocardial infarction and stroke. Results: Over an average of 54.81±18.60 months follow-up, 584 (6.7%) CVEs occurred. Kaplan-Meier and multivariate Cox regression analyses showed that elevated Lp(a) levels had a significant association with CVEs in hypertensive patients, regardless of the control status of blood pressure, but not in normotensive subjects. Moreover, when subgrouping according to both Lp(a) categories and hypertension status, the risk for CVEs was only significantly elevated in high Lp(a) plus hypertension group compared with the reference group with low Lp(a) levels and normotension (hazard ratio: 1.85, 95% confidence interval: 1.19-2.85). Conclusions: In conclusion, elevated Lp(a) was associated with higher risk for CVEs in CAD patients with hypertension and the coexistence of high Lp(a) concentrations and hypertension greatly worsened the clinical prognosis. Our findings may present a prognostic linkage between hypertension and Lp(a) concentrations in patients with CAD.

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