Evaluation of p-wave Dispersion and Left Atrium Ejection Fraction in Patients with Cardioembolic Ischemic Stroke

Introduction: Studies show that p-wave dispersion and left atrial ejection fraction are predictors of cardiovascular events. Purpose: To verify the association of p-wave dispersion and left atrial ejection fraction with cardioembolic ischemic stroke. Methods: This is an observational, cross-sectional, case-control study with 61 patients, mean age of 65.6, with sinus rhythm ischemic stroke who underwent clinical evaluation with CHA2DS2-VASc score, electrocardiogram, echocardiogram and ultrasonography with Doppler of both carotid and vertebral arteries. The groups were divided into cardioembolic (cases) and non-cardioembolic (controls). The p-wave dispersion was obtained with a 12-lead electrocardiographic tracing at 50 mm/s by subtracting the largest p-wave by the smallest one. Left atrial ejection fraction was obtained using the modified biplane Simpson method. This study was approved by the UERN Research Ethics Committee (# 2,536,483). Results: Mean values for p-wave dispersion were 62.5 ms for cases and 49 ms for controls (p = 0.025). For left atrial ejection fraction, the cases presented a mean of 42.9% and the controls a mean of 55.8% (p = 0.003). For the CHA2DS2-VASc score, the mean values were 3.6 and 3.1 for cases and controls, respectively (p = 0.35). Cardiovascular risk factors showed similar distribution in both groups. Conclusion: p-wave dispersion and left atrial ejection fraction were associated with the cardioembolic patients with sinus rhythm that have gone through ischemic stroke.

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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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Abstract 726: Cardiac Sympathetic Nerve System Abnormality Predicts Long-Term Outcome in Patients with Paroxysmal Atrial Fibrillation who did not have Conventional Risk Factors

Circulation ◽

10.1161/circ.118.suppl_18.s_608-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Yasushi Akutsu ◽

Kyouichi Kaneko ◽

Yusuke Kodama ◽

Hui-Ling Li ◽

Jumpei Suyama ◽

...

Keyword(s):

Left Atrial ◽

Structural Heart Disease ◽

Wave Dispersion ◽

P Wave ◽

Cardiac Sympathetic Nerve ◽

Vascular Events ◽

P Wave Dispersion ◽

Sympathetic Nerve System ◽

Nerve System ◽

Conventional Risk Factors

Backgrounds: A history of structural heart disease, heart failure, or stroke increases mortality in patients with atrial fibrillation (AF). However, a useful marker for predicting mortality is not clarified in AF patients without those conventional risks. We recently reported cardiac sympathetic nerve system (SNS) abnormality as a predictor of arrhythmogenic mortality. We hypothesized that SNS abnormality would be associated with increased mortality in patients with paroxysmal AF who didn’t have conventional risk factors. Methods and Results: Iodine-123 metaiodobenzylguanidine scintigraphy was performed to measure Heart/Mediastinum (H/M) ratio as SNS activity in 48 patients (mean ± standard deviation, age: 65 ± 14 years, 65% males) with paroxysmal AF who didn’t have structural heart disease, heart failure, or stroke. P wave dispersion on 12-lead ECG and left atrial dimension on echocardiography were also measured to evaluate structural and electrical properties. Over 11 years follow up, 15 patients (31.3%) transited to permanent AF, and 12 (25%) had cardio/cerebrovascular events. SNS abnormality (defines as H/M ratio <2.7) was a powerful predictor of vascular events (50% in 9 of 18 patients with SNS abnormality vs 10% in 3 of 30 patients without those, p=0.0008). After adjustment for potential confounding variables such as age, gender, P wave dispersion, left atrial dimension, transit to permanent AF, and medications, SNS abnormality remained predictive of vascular events with hazard ratio of 6.9 [95% confidence interval, 1.9 to 25.7 (p=0.004)]. Conclusion: SNS abnormality is predictive of mortality in patients with paroxysmal AF who did not have conventional risk.

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P-032 Left atrial hypertrophy and P wave shape abnormalities impact the P wave dispersion

EP Europace ◽

10.1016/eupace/4.supplement_2.b74-a ◽

2003 ◽

Vol 4 (Supplement_2) ◽

pp. B74-B74

Author(s):

P. Kukla ◽

K. Plazinski ◽

K. Szczuka ◽

T. Slowiak-Lewinska ◽

A. Bromblik

Keyword(s):

Left Atrial ◽

Wave Dispersion ◽

P Wave ◽

Wave Shape ◽

P Wave Dispersion

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Correlation of P-wave dispersion with insulin sensitivity in obese adolescents

Cardiology in the Young ◽

10.1017/s1047951116000366 ◽

2016 ◽

Vol 27 (2) ◽

pp. 229-235 ◽

Cited By ~ 2

Author(s):

Ahmet Sert ◽

Eyup Aslan ◽

Muammer Buyukınan ◽

Ozgur Pirgon

Keyword(s):

Insulin Resistance ◽

Regression Analysis ◽

Left Atrial ◽

Density Lipoprotein ◽

Wave Dispersion ◽

P Wave ◽

Lipoprotein Cholesterol ◽

Model Assessment ◽

P Wave Dispersion ◽

Obese Adolescents

AbstractBackgroundP-wave dispersion is a new and simple electrocardiographic marker that has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. In the present study, we evaluated P-wave dispersion in obese adolescents and investigated the relationship between P-wave dispersion, cardiovascular risk factors, and echocardiographic parameters.MethodsWe carried out a case–control study comparing 150 obese adolescents and 50 healthy controls. Maximum and minimum P-wave durations were measured using a 12-lead surface electrocardiogram, and P-wave dispersion was calculated as the difference between these two measures. Echocardiographic examination was also performed for each subject. Multivariate linear regression analysis with stepwise variable selection was used to evaluate parameters associated with increased P-wave dispersion in obese subjects.ResultsMaximum P-wave duration and P-wave dispersion were significantly higher in obese adolescents than control subjects (143±19 ms versus 117±20 ms and 49±15 ms versus 29±9 ms, p<0.0001 for both). P-wave dispersion was positively correlated with body mass index, waist and hip circumferences, systolic and diastolic blood pressures, total cholesterol, serum levels of low-density lipoprotein cholesterol, triglycerides, glucose, and insulin, homoeostasis model assessment for insulin resistance score, left ventricular mass, and left atrial dimension. P-wave dispersion was negatively correlated with high-density lipoprotein cholesterol levels. By multiple stepwise regression analysis, left atrial dimension (β: 0.252, p=0.008) and homoeostasis model assessment for insulin resistance (β: 0.205; p=0.009) were independently associated with increased P-wave dispersion in obese adolescents.ConclusionsInsulin resistance is a significant, independent predictor of P-wave dispersion in obese adolescents.

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