How valuable is P-wave dispersion in the determination of carboxyhemoglobin levels?

Objective: To determine whether or not wave/interval dispersions in electrocardiography (ECG) are increased, and to define whether wave and interval dispersions are correlated with carboxyhemoglobin (COHb) levels. Methods: ECG, complete blood count, and biochemical parameters were taken from 87 patients with carbon monoxide (CO) poisoning as well as 90 control patients with similar age, gender, and body mass index distribution. COHb levels were recorded in CO-poisoning patients. The COHb levels and the relationships with ECG parameters were studied. Results: Pmax, Pmin, Pd, PRmax, PRmin, PRd, QTmax, QTmin, QTd, cQTmax, cQTmin, cQTd, Tmax, Tmin, and Td in ECG were higher in intoxicated patients than the control group ( p < 0.05 for all). Pearson’s correlation analyses showed moderately significant positive correlations between COHb level and Pmax ( r = 0.224; p = 0.037) and Pd ( r = 0.222; p = 0.039). The receiver–operator characteristic (ROC) curve showed that a Pd value of 38 ms determined by ECG separates patients with a COHb ≥ 20% with area under the ROC curve of 0.78 (95%CI = 0.71–0.83), a sensitivity of 67.9% (95%CI = 59.4–75.6), a specificity of 95% (95%CI = 83.0–99.2], a positive predictive value of 97.9% (95%CI = 92.5–99.7), and a negative predictive value of 46.3% (95%CI = 35.3–57.7.) Conclusion: A significant increase in wave/interval dispersions in the ECG of CO-poisoning patients compared with controls may show that not only a part is affected but both atrium and the ventricles as a whole are affected by hypoxic ischemia. When COHb levels of the patients are unavailable, P dispersion on ECG may show CO poisoning level of the patient.

Download Full-text

Impaired atrial electromechanical coupling in lichen planus patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.109 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

I Jafaripour ◽

Z Aryanian ◽

S Hosseinzadeh ◽

R Pourkia ◽

MM Ansari Ramandi ◽

...

Keyword(s):

Lichen Planus ◽

Electromechanical Coupling ◽

Wave Dispersion ◽

Tissue Doppler ◽

P Wave ◽

Control Group ◽

P Value ◽

P Wave Dispersion ◽

Increased Risk ◽

Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Lichen planus (LP) which is a chronic inflammatory disease can cause impaired atrial electromechanical coupling, leading to increased risk of atrial fibrillation. Purpose The present study aimed to evaluate atrial electromechanical coupling in LP patients by using electrocardiography (ECG) and echocardiography. Methods Forty-six LP patients were investigated in this cross-sectional case-control study. The control group comprised healthy individuals selected in age and gender-matched manner. Echocardiography and ECG were done for all patients to show inter and intra-atrial electromechanical delays and P wave dispersion respectively. The electromechanical delays were calculated by using the difference between the delays from the onset of the P wave on ECG to the onset of A wave on tissue Doppler recordings of the different areas. Results The baseline characteristics of the case and control group were similar and did not differ significantly. The P wave dispersion was 45.63 ± 3.48 milliseconds in the LP group in comparison to 36.56 ± 2.87 milliseconds in the control group (p < 0.001). As shown in the table, the intra and inter-atrial electromechanical delays were also significantly prolonged in LP patients when compared to the control group (p < 0.001). There was no significant difference between the left and right ventricular systolic function and diastolic function of the two groups. Conclusion The results of the study indicate the presence of significant impaired atrial electromechanical coupling in patients with LP confirmed by both electrocardiographic and echocardiographic tools. Electromechanical delays Case N = 46 (mean ± SD) Control N = 46 (mean ± SD) P value Septal - PA (msec) 59.71 ± 13.24 44.39 ± 11.07 0.002 Lateral - PA (msec) 55.71 ± 13.26 48.89 ± 11.21 0.009 Tricuspid - PA (msec) 52.37 ± 13.12 43.28 ± 10.58 0.002 Inter-atrial delay (msec) (lateral PA−RV PA) 8.47 ± 1.62 6.37 ± 1.36 <0.001 Intra-atrial delay (msec) (LA) [lateral PA−septal PA] 4.80 ± 1.48 3.83 ± 0.82 <0.001 Intra-atrial delay (msec) (RA) [septal PA−RV PA] 3.91 ± 0.96 2.02 ± 0.71 <0.001 PA Delay from the onset of the P wave on ECG to the onset of A wave on tissue Doppler, N: number, SD: Standard Deviation, LA: Left Atrium, RA: Right Atrium, RV: Right Ventricle

Download Full-text

P wave dispersion, Tpeak–Tend interval, and Tp-e/QT ratio in children with psoriasis

Cardiology in the Young ◽

10.1017/s1047951119002968 ◽

2020 ◽

Vol 30 (3) ◽

pp. 318-322

Author(s):

Mecnun Çetin ◽

İbrahim H. Yavuz ◽

Mehmet Gümüştaş ◽

Göknur Ö. Yavuz

Keyword(s):

Wave Dispersion ◽

P Wave ◽

Cardiac Conduction ◽

Control Group ◽

Healthy Children ◽

P Wave Dispersion ◽

System Disease ◽

Increased Risk ◽

Electrocardiographic Parameters ◽

Key Indicators

AbstractBackground:Psoriasis is a chronic inflammatory, multi-system disease that often begins in childhood and characterised by inflammatory skin, nails, scalp, and joint manifestations. The inflammation in psoriasis may promote some effect on the cardiac conduction system.Objective:The aim of this study is to investigate myocardial repolarisation anomaly on the conducting system in the paediatric psoriasis using P wave dispersion, Tpeak–Tend interval, and Tp-e/QT ratio.Methods:Forty-two patients diagnosed with psoriasis and 37 age- and sex-matched healthy children were enrolled in the study. Electrocardiographic parameters in psoriasis and control group were recorded from an electrocardiogram for each patient.Results:The results indicated that the parameters including Pdis, QTc dis, Tp-e dis interval, and Tp-e max/QTmax ratios, which are known to be key indicators for the prediction of severe atrial or ventricular arrhythmia and sudden cardiac death and also important parameters used as the indicators for the non-invasive evaluation of the transmural heterogeneity were significantly longer in the study group compared to the control group (p < 0.05).Conclusions:This study includes the evidence linking psoriasis with increased myocardial repolarisation heterogeneity. These findings suggest that this patient population may be at an increased risk for arrhythmias. Our findings may be a basis for further studies.

Download Full-text

Increased QT and P-wave dispersion during attack-free period in pediatric patients with migraine attacks

Cardiology in the Young ◽

10.1017/s1047951119000088 ◽

2019 ◽

Vol 29 (4) ◽

pp. 488-491

Author(s):

Oyku Tosun ◽

Elif Karatoprak

Keyword(s):

Wave Dispersion ◽

P Wave ◽

Sympathetic System ◽

Control Group ◽

Qtc Interval ◽

Control Groups ◽

P Wave Dispersion ◽

Surface Ecg ◽

Migraine Group ◽

And Control

AbstractIntroduction:Migraine is a common neurovascular disease characterised with recurrent attacks by pain-free periods. It has been suggested that both sympathetic and parasympathetic dysfunctions play a role in its pathophysiology.Aim:The aim of our study was to investigate the ECG changes during attack-free period in children with migraine, in terms of QTc interval, QTc, and P-wave dispersion to evaluate the autonomic nervous system disturbance.Methods:Sixty children who were diagnosed with migraine were included as patient group and 50 healthy, age- and body mass index-matched children who were examined for innocent murmur were included as control group. The patients’ routine ECG records were screened from the outpatient clinic files. The durations of P-wave, QT, and QTc intervals and dispersion values and heart rates (beats/minute) were compared between the patient and control groups.Results:P maximum and P dispersion were significantly higher, and P minimum was significantly lower in the migraine group compared with the control group. QT–QTc maximum and QT–QTc dispersion were significantly higher and QT–QTc minimum was significantly lower in the migraine group compared with the control group.Conclusion:According to our findings, although migraine patients were asymptomatic and no arrhythmia was detected in the surface ECG, sympathovagal balance in the sympathetic system, which may be disrupted in favour of the sympathetic system, should continue even in the attack-free period, and we should be careful in terms of serious arrhythmias that may develop in these patients.

Download Full-text

Effect of Coronary Slow Flow on Intrinsicoid Deflection of QRS Complex

Cardiology Research and Practice ◽

10.1155/2018/2451581 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Sabri Seyis

Keyword(s):

Wave Dispersion ◽

Left Ventricular ◽

P Wave ◽

Control Group ◽

Slow Flow ◽

Pathophysiological Mechanism ◽

P Wave Dispersion ◽

Benign Condition ◽

Coronary Syndrome ◽

Coronary Slow Flow

Coronary slow flow is a rare, clinically important entity observed in acute coronary syndrome. The pathophysiological mechanism is not fully elucidated. We investigated patients with chest pain who had angiographic features consistent with the coronary slow flow. One hundred ten patients were included. Electrocardiography, echocardiography, and angiography results were retrospectively noted. The mean age was 56.4. Fifty-eight were male, and fifty-two were female. The control group consisted of patients with normal angiography. Patients had higher diastolic blood pressure, lower mean ejection fraction, higher average left ventricular end-diastolic diameter, and higher mean left atrial size than the control group (p=0.009,p=0.017,p=0.041,andp<0.001, resp.). Patients had higher average V1 ID, V6 ID, P wave dispersion, TFC LAD, TFC Cx, TFC RCA, and TFC levels than the control group. A significant linear positive relationship was found between the V1 ID and the TFC LAD, TFC Cx, TFC RCA, and TFC; also between the V6 ID and the TFC LAD, TFC Cx, TFC RCA, and TFC. Angiographic and electrocardiographic features are suggestive and diagnostic for the coronary slow flow syndrome. Although when regarded as a benign condition, coronary slow flow should be diagnosed, followed up, and treated as many of laboratory features suggest ischemic events.

Download Full-text

P-Wave Duration and Dispersion in Patients with Mitral Stenosis

10.21203/rs.3.rs-200176/v1 ◽

2021 ◽

Author(s):

Wenxia Fu ◽

Jiawei Le ◽

Xijin Wei ◽

lixiu chen ◽

Wenzhao Li ◽

...

Keyword(s):

Mitral Stenosis ◽

Test Group ◽

Wave Dispersion ◽

Left Ventricular ◽

P Wave ◽

Control Group ◽

P Wave Dispersion ◽

Wave Duration ◽

P Wave Duration ◽

Increased Risk

Abstract Background: Mitral stenosis (MS) is related to prolonged inter- and intra-atrial electromechanical delays and increased P-wave dispersion. The objective of the current study was to investigate the correlation between the P-wave duration, P-wave dispersion (PWD), mitral stenosis (MS) and to explore the cut-off values for predicting the MS in the patients.Methods: We enrolled 62 patients with MS and sinus rhythm as test group, and 62 healthy subjects matched in age- and sex- were selected as control group. We conducted the 12-lead electrocardiogram and echocardiography for all the subjects. The maximum and the minimum P-wave duration and PWD were calculated. Univariate and multivariate logistic regression analyses were performed to demonstrate the correlation between P-wave duration and PWD and MS. The receiver operating characteristic (ROC) curve was drawn to detect the threshold of P-wave duration and PWD for predicting the MS.Results: There were significant differences in the left atrial diameter (45.00±5.78 vs. 32.31±4.24 cm2), pulmonary artery pressure (46.68±17.29 vs. 32.64±2.86 mm Hg), left ventricular end-diastolic diameter (47.57±4.80 vs. 45.58±5.04 cm), ejection fraction (63.10±3.05 vs. 65.13±2.56%), aortic root inside diameter (29.60±3.50 vs. 31.58±3.58) and pulmonary trunk (24.17±2.78 vs. 22.23±1.77) values between the test group and the control group. Besides, the test subjects had significantly longer maximum P-wave duration (123.42±12.33 vs. 108.18±9.07) and larger P-wave dispersion (47.24±13.61 vs. 28.94±9.19). In the multivariate analysis, maximum P-wave duration (OR:1.221, 95% CI:1.126-1.324) and P-wave dispersion (OR:1.164, 95% CI:1.094-1.238) were correlated with the occurrence of MS. The optimal threshold for the maximum P-wave duration and PWD were 119.50ms, and 42.50ms, respectively, and the areas under the curve were 0.859 and 0.865, respectively. Conclusions: A longer P-wave duration and a higher PWD are correlated with the increased risk of MS progression.

Download Full-text

Evaluation of P Dispersion and P Dispersion Recovery in Patients with Pseudoexfoliative Syndrome

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol04-i05/636 ◽

2019 ◽

Vol 4 (05) ◽

Author(s):

Cosgun Ayhan ◽

Gunes Alper

Keyword(s):

Outpatient Clinic ◽

Stress Test ◽

Wave Dispersion ◽

P Wave ◽

Control Group ◽

Study Group ◽

P Wave Dispersion ◽

The Third ◽

Significant Difference ◽

The Difference

Background: Pseudoexfoliative syndrome (PEX) is an old-age disease characterized by the accumulation of fibril materials in both the eye and extraocular organs. PEX is associated with many morbid and mortal cardiovascular diseases. The aim of our study was to investigate the effects of the stress test on P Wave dispersion (PWD) in patients with PEX. Patients and Methods: Forty patients who presented to the ophthalmology outpatient clinic between February 2018 and September 2018 and diagnosed as PEX in the ophthalmologic examination were included in the study. As a control group, forty-four patients, age and gender-matched, who applied to the cardiology outpatient clinic, diagnosed in the outpatient clinic of ophthalmology non-PEX, were included in the study. The study and control group were subjected to treadmill exercise test (TET) according to Bruce protocol. Results: The recovery PWD value of the study group in the third minutes was 34.4 ±4.35 ms and rest PWD value of study group 32.925±5.17 ms. There was no statistically significant difference between the two values (t=1.37992, p=0.08). The basal PWD value of the control group was 31.79±3.9ms, the recovery PWD value of the control group in the second minute 32.65±3.48 ms. There was no statistically significant difference between the two values (t=1.09495, p=0.13). Conclusion: The most interesting result of the study was that the difference between the recovery PWD value and the resting PWD value in the study group was statistically insignificant in the third recovery minute, whereas in the control group it occurred in the second minute.

Download Full-text

P wave dispersion in patients with erectile dysfunction

Interventional Medicine and Applied Science ◽

10.1556/1646.11.2019.10 ◽

2019 ◽

Vol 11 (2) ◽

pp. 101-105

Author(s):

Can Ramazan Öncel ◽

Ali Akkoç

Keyword(s):

Erectile Dysfunction ◽

Demographic Data ◽

Wave Dispersion ◽

P Wave ◽

Control Group ◽

Healthy Controls ◽

P Wave Dispersion ◽

Wave Duration ◽

P Wave Duration ◽

Severity Of The Disease

Background and aims P wave dispersion (PWD) has been reported to be a non-invasive electrocardiographic predictor for atrial fibrillation. The aim of this study is to evaluate PWD between men with erectile dysfunction (ED) and healthy controls in order to investigate whether PWD was prolonged in patients with ED and related to severity of the disease. Methods This study included a total of 72 men (42 patients with ED and 30 healthy controls). Demographic data and clinical features were recorded on admission. An electrocardiographic evaluation was obtained to measure PWD values for both patients and controls. Results Maximum P wave duration was 108.5 ± 4.7 and 108.3 ± 4.3 in ED group and control group, respectively (p = 0.748). Minumum P wave duration was significantly higher in the control group than in the ED group. PWD was 48.1 ± 5.9 in the ED group. As a result, PWD was prolonged in patients with ED (48.1 ± 5.9 vs. 38.0 ± 3.9, p < 0.05). A significant negative correlation was observed between IIEF score and PWD values (p < 0.05, r = −0.662). Conclusions Patients with ED exhibited prolonged PWD values compared with normal controls. In addition, PWD was found to be associated with severity of the disease.

Download Full-text

How much apoptosis does carbon monoxide poisoning cause? Primary clinical soluble TWEAK protein level study

Human & Experimental Toxicology ◽

10.1177/0960327119845038 ◽

2019 ◽

Vol 38 (8) ◽

pp. 974-982 ◽

Cited By ~ 1

Author(s):

N Dindar Badem ◽

E Cömertpay ◽

F Coşkun

Keyword(s):

Carbon Monoxide ◽

Peripheral Blood ◽

Protein Level ◽

Cell Apoptosis ◽

Predictive Value ◽

Complete Blood Count ◽

Carbon Monoxide Poisoning ◽

Control Group ◽

Co Poisoning ◽

Arterial Blood

Carbon monoxide (CO) is an important cause of deaths via poisoning. CO poisoning causes inhibition of O2 transport and development of tissue hypoxia, which then causes cell apoptosis. A significant indicator of cell apoptosis, soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) protein, is important for the stimulation of apoptosis. The primary purpose of this study is to determine whether apoptosis occurs during acute CO poisoning and to show that sTWEAK protein is an indicator of apoptosis that can be analyzed as a marker in the peripheral blood sample. The secondary aim is to determine the diagnostic and prognostic values of sTWEAK protein. The study was performed prospectively on 43 patients with CO poisoning and 30 healthy volunteer control individuals. The anamneses were taken from all patients, who also underwent physical examination. Complete blood count, biochemical markers, cardiac enzymes, and arterial blood gas measurements were analyzed. All the patients’ sTWEAK protein levels were also analyzed. The sTWEAK protein level of patients with CO poisoning was 2278 pg/mL (1197–7234), while the level of the control group was 1609 pg/mL (310–3721). The patients’ sTWEAK levels were significantly higher than the controls (area under the curve: 0.77 (0.66–0.89); p < 0.001), and the cutoff value was determined as 1895.50 pg/mL. The cutoff level had a sensitivity of 74.4%, a specificity of 76.7%, a positive predictive value of 82.0%, and a negative predictive value of 67.6%. sTWEAK is a significant indicator of apoptosis in CO poisoning that can be analyzed in the peripheral blood. However, further clinical trials are needed in terms of prognostic criteria.

Download Full-text

P-Wave and QT Dispersion in Children With βeta-Thalassemia

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2020/v32i130348 ◽

2020 ◽

pp. 38-45

Author(s):

Marwa Salama ◽

Shimaa El-Nemr ◽

Ibrahim Badraia ◽

Amr Zoair

Keyword(s):

Qt Dispersion ◽

Wave Dispersion ◽

Thalassemia Major ◽

Left Ventricular ◽

P Wave ◽

Control Group ◽

P Value ◽

Internal Diameter ◽

P Wave Dispersion ◽

Lv Mass

Aim: This study aimed at assessing P-wave and QT interval dispersion in children with β-thalassemia and to correlate them with various laboratory and echocardiographic data. Methodology: Subjects comprised of 30 children with β-thalassemia major as the patient group. 30 healthy children matched for age and sex served as the control group. All patients were evaluated clinically as well as by echocardiography and 12 leads ECG. The type of study is prospective case control study. Results: There was a statistically significant increase of Interventricular Septal end diastole (IVSd), Interventricular Septal end systole (IVSs), Left Ventricular Internal Diameter end diastole (LVIDd), Left Ventricular Internal Diameter end systole (LVIDs) and Left Ventricular Posterior Wall end diastole (LVPWd) in patients as compared to controls (Mean ±SD = 0.950±0.166, 0.863±0.103, 3.983±0.456, 2.947±0.535a nd 0.797±0.165 respectively) (P < 0.05). Moreover, there were a significant increase of LV mass (Mean ±SD = 107.267±26.736, P= 0.002) and LV mass index of the studied patients (Mean ±SD = 106.900±22.651, P = 0.005) compared to the controls. There were significant decrease of ejection fraction (EF%)( Mean ±SD = 60.373 ± 8.088, P = 0.032)and fractional shortening (FS%) (Mean ±SD = 29.495 ± 4.171, P = 0.026) of the studied patients compared to control group. Both P wave dispersion (PWd) (Mean ±SD = 33.667 ± 13.767, P = 0.029) and QT dispersion (QTd) (Mean ±SD = 53.000 ± 18.411, P = 0.001) were significantly higher in patients compared to controls. There was a significant positive correlation between PWd and serum ferritin (r =0.551, P-value= 0.002), LVIDd (r =0.406, P-value= 0.026), LVPWd (r =0.461, P-value= 0.010), LV mass (r =0.412, P-value= 0.024), and LV mass index(r = 0.379, P-value= 0.039). While, there were a significant positive correlations between QTd and serum ferritin (r =0.654, P-value <0.001), LVIDd (r = 0.388, P-value = 0.034), LV mass (r = 0.454, P-value = 0.012) and LV mass index (r = 0.456, P-value = 0.011). Conclusion: P wave dispersion and QT dispersion were prolonged in children with β-thalassemia major denoting cardiac autonomic dysfunction with homogeneity disorders of atrial conduction and ventricular repolarization in these patients.

Download Full-text

Assessment of P-wave dispersion in children with atrial septal aneurysm

Cardiology in the Young ◽

10.1017/s1047951113001431 ◽

2013 ◽

Vol 24 (5) ◽

pp. 918-922 ◽

Cited By ~ 1

Author(s):

Derya Arslan ◽

Derya Cimen ◽

Osman Guvenc ◽

Bulent Oran ◽

Fatma Hilal Yilmaz

Keyword(s):

Wave Dispersion ◽

P Wave ◽

Controlled Study ◽

Control Group ◽

Atrial Septal Aneurysm ◽

P Wave Dispersion ◽

Wave Duration ◽

P Wave Duration ◽

Significant Difference ◽

Echocardiographic Parameters

AbstractBackgroundThis was a prospective controlled study to determine the P-wave duration and P-wave dispersion in patients with atrial septal aneurysm.MethodsA total of 41 children with atrial septal aneurysm, including 21 boys and 20 girls (mean age 11.85 ± 3.8 years), and 32 controls, including 17 boys and 15 girls (mean age 12.3 ± 2.9 years), were included. P-wave dispersion was calculated from the 12-lead electrocardiogram. Cardiac functions, morphology of the aneurysm, and left atrial diameter were measured using conventional echocardiography. The diagnosis of atrial septal aneurysm was made when the base of the aneurysms with an excursion ratio ≥25% was found on echocardiography.ResultsThere was no significant difference between the patient and control groups in demographic, clinical findings, and M-mode echocardiographic parameters. The P-wave dispersion in patients with atrial septal aneurysm was significantly longer compared with the control group (64.4 ± 13.4 ms; p < 0.0001). Similarly, the the maximum duration of the P wave in the patient group was significantly longer compared with the control group (106.1 ± 13.3 ms; p < 0.001). The P-wave duration and dispersion were not correlated with age, gender, systolic and diastolic blood pressure, or m-mode echocardiographic parameters.ConclusionsThis study shows that P-wave dispersion is delayed in atrial septal aneurysm patients. Prolonged P-wave dispersion was determined to indicate electrical disturbance, and therefore it has an increased electrocardiographic risk of atrial arrhythmia in children with atrial septal aneurysm.

Download Full-text