scholarly journals Automatically assessed P‐wave predicts cardiac events independently of left atrial enlargement in patients with cardiovascular risks: The Japan Morning Surge Home Blood Pressure Study

2020 ◽  
Author(s):  
Ayako Yokota ◽  
Tomoyuki Kabutoya ◽  
Satoshi Hoshide ◽  
Kazuomi Kario
Keyword(s):  
Blood Pressure ◽  
Left Atrial ◽  
Home Blood Pressure ◽  
P Wave ◽  
Cardiovascular Risks ◽  
Cardiac Events ◽  
Left Atrial Enlargement ◽  
Blood Pressure Study ◽  
Atrial Enlargement

Abstract 14469: The Automatically Assessed P-wave Notch Associated With Not Only Left Atrial Enlargement but Also Cardio-ankle Vascular Index in Patients With Cardiovascular Risks: The Coupling Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Tomoyuki Kabutoya ◽  
Satoshi Hoshide ◽  
Kazuomi Kario
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Left Atrial ◽  
P Wave ◽  
Smoking History ◽  
Cardiovascular Risks ◽  
Left Atrial Enlargement ◽  
Wave Characteristics ◽  
Atrial Enlargement

Background: The notched P-wave characteristics is associated with atrial remodeling. However, the relationship between notched P-wave characteristics and atherosclerosis remains unclear. Hypothesis: We hypothesized that notched P-wave would associated with measurements of atherosclerosis in patients with cardiovascular risk factors. Methods: We enrolled 4,877 subjects from the coupling Study who had ≥1 of cardiovascular risk factors. Twelve-lead electrocardiography was conducted, and the peak-to-peak distance in the M-shape was calculated automatically using a 12-lead ECG Analysis system (Fukuda Denshi, Tokyo). P waves were defined as "notched" if the peak-to-peak distance in the M-shape was ≥40 msec in lead II. We measured cardio-ankle vascular (CAVI), NT-proBNP, and Troponin T. We also assessed the left atrial diameter and left ventricular mass index (LVMI) by echocardiography in 501 patients. Results: The CAVI with notched P wave were significantly higher than those in the patients without notched P wave (9.75±1.56 vs. 8.86±1.37, p<0.001). The LA diameter, LVMI, and BNP in the patients with notched P wave were significantly higher than those in the patients without notched P wave (LA dia.: 40.2±7.0 vs. 37.0±5.0 mm, p=0.008; LVMI: 105.7±25.7 vs. 96.9±25.2 g/m 2 , p<0.001; median BNP: 41.6 vs. 16.5 pg/dL, p<0.001). A multivariate regression analysis including age, gender, smoking, history of hypertension, dyslipidemia, diabetes revealed that notched P wave was independently associated with an increase of CAVI (odds ratio 2.14, 95%CI 1.40-3.27, p<0.001). Conclusions: The automatically assessed P-wave notch associated with not only left atrial enlargement but also CAVI in patients with cardiovascular risks.

scholarly journals Succinate links atrial dysfunction and cardioembolic stroke

Neurology ◽  
2019 ◽  
Vol 92 (8) ◽  
pp. e802-e810 ◽  
Author(s):  
Sarah E. Nelson ◽  
Zsuzsanna Ament ◽  
Zoe Wolcott ◽  
Robert E. Gerszten ◽  
W. Taylor Kimberly
Keyword(s):  
Left Atrial ◽  
Recurrence Risk ◽  
P Wave ◽  
Stroke Recurrence ◽  
Stroke Subtype ◽  
Left Atrial Enlargement ◽  
Logistic Regression Models ◽  
Liquid Chromatography Tandem Mass ◽  
Atrial Enlargement ◽  
Left Atrial Dysfunction

ObjectiveTo determine whether altered metabolic profiles represent a link between atrial dysfunction and cardioembolic (CE) stroke, and thus whether underlying dysfunctional atrial substrate may contribute to thromboembolism risk in CE stroke.MethodsA total of 144 metabolites were measured using liquid chromatography–tandem mass spectrometry in plasma samples collected within 9 hours of stroke onset in 367 acute stroke patients. Stroke subtype was assigned using the Causative Classification of Stroke System, and CE stroke (n = 181) was compared to non-CE stroke (n = 186). Markers of left atrial dysfunction included abnormal atrial function (P-wave terminal force in lead V1, PTFV1 >4,000 μV·ms), left atrial enlargement on echocardiography, and frank atrial fibrillation on ECG. Stroke recurrence risk was assessed using CHADS2 and CHA2DS2-VASc scores. Associations between metabolites and CE stroke, atrial dysfunction, and stroke recurrence risk were evaluated using logistic regression models.ResultsThree tricarboxylic acid metabolites—succinate (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.36–2.15, p = 1.37 × 10−6), α-ketoglutarate (OR 1.62, 95% CI 1.29–2.04, p = 1.62 × 10−5), and malate (OR 1.58, 95% CI 1.26–1.97, p = 2.57 × 10−5)—were associated with CE stroke. Succinate (OR 1.36, 95% CI 1.31–1.98, p = 1.22 × 10−6), α-ketoglutarate (OR 2.14, 95% CI 1.60–2.87, p = 2.08 × 10−8), and malate (OR 2.02, 95% CI 1.53–2.66, p = 1.60 × 10−7) were among metabolites also associated with subclinical atrial dysfunction. Of these, succinate was also associated with left atrial enlargement (OR 1.54, 95% CI 1.23–1.94, p = 1.06 × 10−4) and stroke recurrence based on dichotomized CHADS2 (OR 2.63, 95% CI 1.68–4.13, p = 3.00 × 10−6) and CHA2DS2-VASc (OR 2.43, 95% CI 1.60–3.68, p = 4.25 × 10−6) scores.ConclusionsMetabolite profiling identified changes in succinate associated with CE stroke, atrial dysfunction, and stroke recurrence, revealing a putative underlying link between CE stroke and energy metabolism.

scholarly journals Diagnostic performance of P wave duration in the identification of left atrial enlargement in dogs

2012 ◽  
Vol 53 (5) ◽  
pp. 267-272 ◽  
Author(s):  
P. Savarino ◽  
M. Borgarelli ◽  
A. Tarducci ◽  
S. Crosara ◽  
N. M. Bello ◽  
...  
Keyword(s):  
Left Atrial ◽  
Diagnostic Performance ◽  
P Wave ◽  
Left Atrial Enlargement ◽  
Wave Duration ◽  
P Wave Duration ◽  
Atrial Enlargement

Assessment of electrocardiographic criteria of left atrial enlargement

2018 ◽  
Vol 26 (4) ◽  
pp. 273-276 ◽  
Author(s):  
Mahesh Kumar Batra ◽  
Atif Khan ◽  
Fawad Farooq ◽  
Tariq Masood ◽  
Musa Karim
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Gold Standard ◽  
Left Atrial ◽  
Standard Technique ◽  
P Wave ◽  
Left Atrial Enlargement ◽  
Atrial Enlargement ◽  
Dimensional Echocardiography ◽  
Gold Standard Technique

Background Left atrial enlargement is considered to be a robust, strong, and widely acceptable indicator of cardiovascular outcomes. Echocardiography is the gold standard for measurement of left atrial size, but electrocardiography can be simple, cost-effective, and noninvasive in clinical practice. This study was undertaken to assess the diagnostic accuracy of an established electrocardiographic criterion for left atrial enlargement, taking 2-dimensional echocardiography as the gold-standard technique. Methods A cross-sectional study was conducted on 146 consecutively selected patients with the complaints of dyspnea and palpitation and with a murmur detected on clinical examination, from September 10, 2016 to February 10, 2017. Electrocardiography and echocardiography were performed in all patients. Patients with a negative P wave terminal force in lead V1 > 40 ms·mm on electrocardiography or left atrial dimension > 40 mm on echocardiography were classified as having left atrial enlargement. Sensitivity and specificity were calculated to assess the diagnostic accuracy. Results Taking 2-dimensional echocardiography as the gold-standard technique, electrocardiography correctly diagnosed 68 patients as positive for left atrial enlargement and 12 as negative. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of electrocardiography for left atrial enlargement were 54.4%, 57.1%, 88.3%, 17.4%, and 54.8%, respectively. Conclusion The electrocardiogram appears to be a reasonable indicator of left atrial enlargement. In case of nonavailability of echocardiography, electrocardiography can be used for diagnosis of left atrial enlargement.

Assessment of atrial electromechanical delay in children with acute rheumatic fever

2012 ◽  
Vol 24 (1) ◽  
pp. 27-32
Author(s):  
Murat Çiftel ◽  
Özlem Turan ◽  
Ayşe Şimşek ◽  
Fırat Kardelen ◽  
Gayaz Akçurin ◽  
...  
Keyword(s):  
Rheumatic Fever ◽  
Left Atrial ◽  
Acute Rheumatic Fever ◽  
Wave Dispersion ◽  
P Wave ◽  
Electromechanical Delay ◽  
P Wave Dispersion ◽  
Left Atrial Enlargement ◽  
Atrial Electromechanical Delay ◽  
Atrial Enlargement

AbstractPurposeThere may be an increase in the risk of atrial arrhythmia due to left atrial enlargement and the influence on conduction system in acute rheumatic fever. The aim of this study is to investigate atrial electromechanical delay and P-wave dispersion in patients with acute rheumatic fever.PatientsA total of 48 patients diagnosed with acute rheumatic fever and 40 volunteers of similar age, sex, and body mass index were included in the study. The study groups were compared for M-mode echocardiographic parameters, interatrial electromechanical delay, intra-atrial electromechanical delay, and P-wave dispersion.ResultsMaximum P-wave duration, P-wave dispersion, and interatrial electromechanical delay were significantly higher in patients with acute rheumatic fever compared with the control group (p < 0.001). However, there was no difference in terms of intra-atrial electromechanical delay (p > 0.05). For patients with acute rheumatic fever, a positive correlation was identified between the left atrium diameter and the P-wave dispersion and interatrial electromechanical delay (r = 0.524 and p < 0.001, and r = 0.351 and p = 0.014, respectively). Furthermore, an important correlation was also identified between the P-wave dispersion and the interatrial electromechanical delay (r = 0.494 and p < 0.001).ConclusionThis study shows the prolongation of P-wave dispersion and interatrial electromechanical delay in acute rheumatic fever. Left atrial enlargement can be one of the underlying reasons for the increase in P-wave dispersion and interatrial electromechanical delay.

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