P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease

New electrocardiographic aspects of the P wave: Its value in clinical cardiology

In this article, we will comment on new aspects of P-wave morphology that help us to better diagnose atrial blocks and atrial enlargement, and their clinical implications. These include: (1) Atypical ECG patterns of advanced interatrial block; (2) The ECG diagnosis of left atrial enlargement versus interatrial block; (3) Atrial fibrillation and advanced interatrial block: The two sides of the same coin; and (4) P-wave parameters: Clinical implications.

Evaluation of the Cardiac Conduction System in Fibromyalgia Patients With Complaints of Palpitations

Objective

This study aimed to investigate the influence of fibromyalgia syndrome (FMS) on the cardiac conduction system and assess patients’ palpitation complaints using 24-h ambulatory ECG (Holter {Maynard, MA: Northeast Monitoring, Inc.}) monitoring.

Methods

Ninety patients with FMS and 70 healthy controls were included in this research. ECG was performed on all participants, and ECG parameters were calculated. Holter monitoring was conducted, and the recordings were analyzed. The results of time-domain heart rate variability (HRV) were evaluated.

Results

The patient group’s mean age was 38.3±6.3 years. There were no statistically significant differences in demographic or laboratory parameters across the groups (p>0.05). The findings of a 24-h Holter ECG recording did not vary significantly between the groups (p=0.182). In the study group, the values for the standard deviation of R-R intervals (SDNN), low frequency (LF), and low/high frequency (LF/HF), which are known as HRV indicators, were substantially different between the two groups (p<0.05).

Conclusions

The study indicated that the risk of arrhythmias did not increase even though FM patients complained of palpitations.

Atrial electromechanical delay is impaired in patients with COVID-19

Background: COVID-19 infection has the potential to affect the cardiovascular system. Intra/ interatrial electromechanical delay (EMD) demonstrated by P wave dispersion (PD) and tissue doppler echocardiography (TDE) is related to the development of atrial fibrillation. This study aimed to investigate atrial conduction time by PD and TDE in patients with COVID-19. Material and Method: A total of 143 participants were selected in the current study. The COVID-19 group included 90 subjects and the control group included 53 individuals. Two groups were compared with each other, in terms of electrocardiographic P wave measurements, and atrial electromechanical coupling (AEC) parameters by TDE. Results: Maximum P-wave duration (Pmax) and PD were significantly higher in COVID-19 patients compared to the control group (p

P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research-A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology

Atrial cardiomyopathy, characterized by abnormalities in atrial structure and function, is associated with increased risk of adverse cardiovascular and neurocognitive outcomes, independent of atrial fibrillation. There exists a critical unmet need for a clinical tool that is cost-effective, easy to use, and that can diagnose atrial cardiomyopathy. P wave parameters (PWPs) reflect underlying atrial structure, size, and electrical activation; alterations in these factors manifest as abnormalities in PWPs that can be readily ascertained from a standard 12-lead ECG and potentially be used to aid clinical decision-making. PWPs include P wave duration, interatrial block, P wave terminal force in V₁, P wave axis, P wave voltage, P wave area, and P wave dispersion. PWPs can be combined to yield an index (P wave index), such as the morphology-voltage-P-wave duration ECG risk score. Abnormal PWPs have been shown in population-based cohort studies to be independently associated with higher risks of atrial fibrillation, ischemic stroke, sudden cardiac death, and dementia. Additionally, PWPs, either individually or in combination (as a P wave index), have been reported to enhance prediction of atrial fibrillation or ischemic stroke. To facilitate translation of PWPs to routine clinical practice, additional work is needed to standardize measurement of PWPs (eg, via semiautomated or automated measurement), confirm their reliability and predictive value, leverage novel approaches (eg, wavelet analysis of P waves and machine learning algorithms), and finally, define the risk-benefit ratio of specific interventions in high-risk individuals. Our ultimate goal is to repurpose the ubiquitous 12-lead ECG to advance the study, diagnosis, and treatment of atrial cardiomyopathy, thus overcoming critical challenges in prevention of cardiovascular disease and dementia.

Roles of Morris Index on Poor Outcomes in Patients with Non-ST Segment Elevation Acute Coronary Syndrome

Background

This study aimed to assess the roles of the Morris index in predicting poor outcomes in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS).

Material/Methods

This study included 905 patients with newly diagnosed NSTE-ACS. The Morris index, also known as P wave terminal force in lead V1 (PTFV1), was recorded at admission and discharge. PTVF1 (+) was defined as an absolute value >0.04 mm·s, while PTFV1 (−) was defined as an absolute value <0.04 mm·s. Based on their PTFV1 values at admission/discharge, patients were divided into 4 groups: PTFV1 (−)/(−), PTFV1 (+)/(−), PTFV1 (−)/(+), and PTFV1 (+)/(+). Univariate and multivariate regression analyses were utilized to identify the variables that could contribute to NSTE-ACS risk.

Results

Compared with the PTFV1 (−)/(−) group, the incidence of poor outcomes was significantly higher in the PTFV1 (−)/(+) (hazard ratio [HR], 3.548; 95% confidence interval [95% CI], 2.024–6.219) and PTFV1 (+)/(+) (HR, 2.133; 95% CI, 1.141–3.986) groups, but not statistically different in the PTFV1 (+)/(−) group (risk ratio, 0.983; 95% CI, 0.424–2.277).

Conclusions

Primary PTFV1 (+) at discharge and PTFV1 (+) during hospitalization were independent risk factors for poor outcomes, which may provide useful prognostic information for patients with NSTE-ACS.

Relationship between P wave peak time and coronary artery disease severity in non-ST elevation acute coronary syndrome

BACKGROUND

Early diagnosis of non-ST elevation acute coronary syndrome (NSTE-ACS) and prediction of the severity of current coronary artery disease (CAD) play a major role in patient prognosis. Electrocardiography has a unique value in the diagnosis and provides prognostic information on patients with NSTE-ACS. In the present study, we aimed to examine the relationship between P wave peak time (PWPT) and the severity of CAD in patients with NSTE-ACS.

METHODS

A total of 132 consecutive patients (female: 35.6%; mean age: 60.1 ± 11.6 years) who were diagnosed with NSTE-ACS were evaluated retrospectively. Gensini scores (GSs) were used to define the angiographic characteristics of the coronary atherosclerotic lesions. The patients were divided into two groups according to the GS. The PWPT was defined as the duration between the beginning and the peak of the P wave, and R wave peak time (RWPT) was defined as the duration between the beginning of the QRS complex and the peak of the R wave.

RESULTS

There were 59 (44.6%) patients in the high-GS group (GS ≥25 ) and 73 (55.3%) patients in the low-GS group (GS <25 ). Presence of diabetes mellitus, low left ventricular ejection fraction, and high RWPT and PWPT were identified as predictors of a high GS in the study population. There was no significant difference between the area under the curves of PWPT and RWPT for predicting the severity of CAD (0.663 vs. 0.623, respectively; p = 0.573).

CONCLUSION

The present study found that both PWPT and RWPT on admission electrocardiography were associated with the severity and complexity of CAD in patients with NSTE-ACS.

The Pattern of Tpeak-Tend Interval and QTdis, and Pdis in Children with Brucellosis

OBJECTIVE

To investigate the effect of inflammation on the conducting system of the heart in patients diagnosed with brucellosis.

METHODS

A total of 42 patients diagnosed with brucellosis and 39 age and sex-matched healthy children were enrolled into the study. Pre- and post-treatment electrocardiographic parameters in brucellosis and control group were recorded from an electrocardiogram for each patient.

RESULTS

The results indicated that the parameters including Pmax, Pdis, QTmax, QTdis, QTcdis, Tp-edis interval and Tp-emax/QTmax and Tp-emax/QTcmax 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 with the control group (p < 0.05).

CONCLUSION

In this study, it was determined that the brucella disease had more cardiac involvement than thought, and this was more in the subclinical form of cardiac involvement.

Prolonged P wave peak time is associated with the severity of coronary artery disease in patients with non-ST segment elevation myocardial infarction

BACKGROUND

Multi-vessel coronary artery disease (CAD) is associated with worse outcome in non-ST segment elevation myocardial infarction (NSTEMI) patients. Depending on the severity of CAD, there may be prolongation of atrial depolarization time as a result of left ventricular dysfunction and atrial ischemia. Therefore, we aimed to study whether the severity of CAD can be predicted with the P wave peak time (PWPT) in the electrocardiography (ECG) obtained during the diagnosis in NSTEMI patients.

METHOD

A total of 162 patients were included. The coronary angiography records of all patients were analyzed and SYNTAX scores were calculated. Patients were divided into two groups, according to CAD severity. In addition to well-known P wave parameters, PWPT, defined as the time from the beginning of the P wave to its peak, was measured in the leads D_II and V₁.

RESULTS

The PWPTs in the leads D_II and V₁ were significantly longer in the group with severe CAD (71 ± 13 vs. 61 ± 12, p < 0.001, 63 ± 24 vs. 53 ± 18, p = 0.024, respectively). PWPT was found to be an independent predictor of severe CAD and the best cut-off value of PWPT in the lead D_II was 69.6 ms with sensitivity of 58.3% and specificity of 78.9%.

CONCLUSION

Our findings show that prolonged PWPT, which is a parameter easily obtainable from the ECG, is associated with severe CAD. Recognition of NSTEMI patients with severe CAD at the time of diagnosis before performing coronary angiography may be important for the planning of treatment.

Coronary Artery Dominance May Predict Future Risk of Atrial Fibrillation

Background

Ischemia of the atria and conductive system of the heart results in greater atrial electrophysiological changes and propensity for atrial fibrillation. P wave duration and dispersion have been proposed to be useful for the prediction of paroxysmal atrial fibrillation (PAF). This study aimed to investigate the effect of coronary artery dominance on P wave duration and dispersion.

Methods

The study population included 194 patients with left dominant circulation (LDC) and 200 age- and gender-matched controls with right dominant circulation (RDC) and without coronary artery disease based on invasive coronary angiography findings. P wave dispersion (PWD) was defined as the difference between the maximum and minimum P wave duration. Arrhythmias were identified by 24-hour Holter electrocardiogram at 3 years of follow-up.

Results

PWD was significantly prolonged in the patients with LDC compared to the controls with RDC (p = 0.001). There were positive correlations between PWD and age (r: 0.502, p = 0.009), left ventricular mass (LVM) (r: 0.614, p = 0.001), LVM index (r: 0.727, p < 0.001) and left atrium (LA) diameter (r: 0.558, p = 0.003) in the LDC group. Multivariate logistic regression analysis showed that age, LVM index, LA diameter and LDC were independent predictors of prolonged PWD. At 3 years of follow-up, 7 (3.9%) patients with LDC and 1 (0.5%) patient with RDC had PAF in Holter electrocardiogram (p < 0.001).

Conclusions

LDC could lead to an increased risk of atrial fibrillation through prolonged PWD. We recommend following up these patients to assess the development of atrial fibrillation.

Are P Wave and QT Dispersions Related to Severe Peripheral Artery Disease?

Background

The aim of this study was to evaluate the relationship between P wave and QT dispersions (PWD and QTD) during the course of severe peripheral artery disease (PAD).

Material/Methods

We recruited 163 patients who underwent peripheral angiography (PA) between August 2011 and March 2017, and they were divided into 2 groups according to the severity of PAD on PA. PWD and QTD were investigated using 12-lead electrocardiograms. Group One consisted of patients diagnosed with <70% stenosis on PA, who eventually received medical treatment; Group Two consisted of patients diagnosed with ≥70% stenosis on PA, who eventually underwent surgery.

Results

ROC curve analysis of the 2 groups demonstrated that PWD was significantly higher in Group Two (AUC: 0.913505; 95% confidence interval (CI): 0.859365 to 0.951788; p<0.0001). The Youden index showed that a cut-off PWD value of >35 msn predicted a peripheral artery stenosis of ≥70% with a sensitivity of 88.89% and a specificity of 85.37% (+LR: 6.07, −LR: 0.13). Moreover, QTD was significantly higher in Group Two (AUC: 0.884749; 95% CI: 0.825489 to 0.929391; p<0.0001). Youden index showed that a cut-off QTD value of >75 msn predicted a peripheral artery stenosis of ≥70% with a sensitivity of 76.54% and a specificity of 85.37% (+LR: 5.23, −LR: 0.27). Comparison of ROC curves showed no difference in terms of predicting peripheral artery stenosis of ≥70% between PWD and QTD (p=0.3308).

Conclusions

Interpreting PWD and QTD offers a non-invasive and cost-effective assessment method for detecting patients at high risk for coronary artery disease in the context of severe PAD.

Prevalence of P wave dispersion and interatrial block in patients with systolic heart failure and their relationship with functional status, hospitalization and one year mortality

Background and objectives

P-wave dispersion (PWD) and Interatrial block (IAB) are common in heart failure (HF), and could be associated with adverse cardiac events. We aimed to assess the prevalence of PWD and IAB and their relationship with functional status, hospitalization and mortality rate in patients with systolic HF.

Methods

We enrolled 110 HF patients in sinus rhythm & LVEF <50%. Patients had undergone clinical evaluation, 6 min walking test (6MWT), 12-lead electrocardiography (ECG), 24-h Holter ECG & echocardiogram. Hospitalization and mortality rate were followed-up for one year. PWD was defined as the difference between maximum & minimum P-wave duration >40 ms. IAB was defined as maximum P duration >110 ms. Measurements were done by 2 blinded investigators using a caliber, a ruler and a magnifying lens.

Results

Mean age was 58.9 ± 9.7 years and 67.3% were males. Prevalence of PWD and IAB was 68.2% and 57.3%, respectively. Patients with PWD showed these features: 84% in NYHA class III or IV HF, 77.4% had LVEF <35%, 78.7% had paroxysmal Atrial Fibrillation (AF) and 89.4% couldn’t complete >200 m (m) in 6MWT. Patients with PWD had more hospitalizations (72% vs 28.6%, P value <0.02) and higher 1-year mortality rate (20% vs 8.6%, P value <0.04) than patients without PWD. Likewise, patients with IAB had nearly similar clinical features, hospitalization and mortality as patients with PWD.

Conclusion

PWD and IAB are prevalent in patients with systolic HF and they are significantly associated with low LVEF, paroxysmal AF, poor functional capacity, hospitalization and mortality rate.

Electrocardiographic alterations in patients consuming synthetic cannabinoids

INTRODUCTION

The aim of this study was to investigate the electrocardiographic parameters in patients consuming synthetic cannabinoids.

METHODS

Thirty-five patients who were consuming synthetic cannabinoids were enrolled to the study, prospectively. The control group included 35 healthy age and sex-matched volunteers. The standard 12-lead surface electrocardiograms of the study population were recorded. P maximum (P_max), P minimum (P_min), P wave dispersion, interatrial duration, P wave area in D2 derivation, abnormal P terminal force in V1 derivation, heart rate, QT interval, corrected QT, QT dispersion, PR interval duration and macrovolt T-wave alternans were evaluated by two experienced cardiologists. The intra-observer and inter-observer variations for all measurements were non-significant.

RESULTS

P_max and P_min duration was not different between the groups ( p=0.96, p=0.15, respectively). However, P wave dispersion was higher in the patient group compared to control group (34±9.4, 29.5±6.6, p=0.02, respectively). QT interval was significantly higher in the patient group than the control group (380.3±25, 365.6±22.8, p=0.01, respectively). Besides, corrected QT was higher in the patient group compared to control group (415±36.8, 392±15.5, p=0.001, respectively). QT dispersion was also higher in the patient group than the control group (39.8±10.0, 29.2±5.4, p<0.001, respectively).

CONCLUSION

Altered electrocardiography parameters linked with atrial and ventricular arrhythmia development may be observed in patients consuming synthetic cannabinoids. These patients should be evaluated regularly for cardiovascular disease and arrhythmia development. The electrocardiogram, which is a cheap and easy test to apply, can be used to determine the pro-arrythmic risk in patients consuming synthetic cannabinoids.

Reversible Increases in Qt Dispersion and P Wave Dispersion during Carbon Monoxide Intoxication

Objectives

Carbon monoxide (CO) is a potent myocardial toxin. We investigated the association between acute CO intoxication and electrocardiographic QT interval (QTmax/QTmin), corrected QT interval (cQTmax/cQTmin), QT dispersion (QTd) and corrected QT dispersion (cQTd), P wave duration (Pmax/Pmin) and P wave dispersion (Pd), which were known as predictors of ventricular arrhythmias, atrial fibrillation and sudden death.

Methods

Electrocardiography with 12-leads and blood gas were taken from 65 patients with CO intoxication as well as 65 control patients with similar age and gender distribution at the admission time to the emergency department and at the 4th hour post-therapy. The carboxyhaemoglobin (COHb) levels and the relationships with electrocardiographic parameters were studied.

Results

The mean COHb levels were 21.43±6.85% and 1.37±0.98% in intoxicated patients and in the control group respectively. QTmax, QTd, cQTmax, cQTd, Pmax, and Pd were found significantly higher in intoxicated patients when compared to the control group (373.98±40.35 vs. 355.98±32.88, p=0.006; 49.29±22.66 vs. 20.43±11.16, p<0.001; 455.38±30.72 vs. 419.57±22.27, p<0.001; 60.88±25.99 vs. 25.75±13.13, p<0.001; 107.91±13.28 vs. 96.65±12.65, p<0.001, 46.85±13.49 vs. 35.22±10.07, p<0.001 respectively). In Pearson correlation analysis, there were significant correlations between COHb level and QTmax, QTd, cQTmax, cQTd, Pmax and Pd (r=0.211, p=0.016; r=0.610, p<0.001; r=0.599, p<0.001; r=0.628, p<0.001; r=0.458, p<0.001; r=0.414, p<0.001 respectively).

Conclusion

A correlation between reversible increases in QTd, cQTmax, cQTd, Pmax and Pd in the electrocardiogram and COHb can be observed in acute CO intoxication patients.

Depression in Cardiovascular Patients in Middle Eastern Populations: A Literature Review

Cardiovascular disease (CVD) is increasing in Middle Eastern countries. Depression is associated with increased morbidity and mortality rates among cardiovascular (CV) patients. Early detection of and intervention for depression among CV patients can reduce morbidity and mortality and save health care costs. Public information on mental health care needs of Arab CV patients living in Middle East regions is scattered and limited. This literature review surveyed and summarized research studies to learn what is known about the relationship between depression and CVD in Middle Eastern populations. The information will raise awareness among health care professionals and policy makers regarding the clinical significance of depression in Arab CV patients. It might contribute to development of culturally appropriate and effective mental health care services. Multiple databases were searched and 60 articles were assessed, including studies that investigated depression in Arab CV patient populations, physiological mechanisms of depression-CVD comorbidity, and intervention strategies that affect CV risk in depressed Arab patients. We discuss the extent to which this issue has been explored in Arab populations living in Middle East regions and Arab populations living abroad. We recommend that more comprehensive and in-depth research studies be conducted with Arab cardiac patients to enable implementation of culturally appropriate and effective mental health care interventions.

P-wave dispersion: What we know till now?

P-wave dispersion is defined as the difference between the maximum and the minimum P-wave duration recorded from multiple different-surface ECG leads. It has been known that increased P-wave duration and P-wave dispersion reflect prolongation of intraatrial and interatrial conduction time and the inhomogeneous propagation of sinus impulses, which are well-known electrophysiologic characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation. Extensive clinical evaluation of P-wave dispersion has been performed in the assessment of the risk for atrial fibrillation in patients without apparent heart disease, in hypertensives, in patients with coronary artery disease, in patients undergoing coronary artery bypass surgery, in patients with congenital heart diseases, as well as in other groups of patients suffering from various cardiac or non-cardiac diseases. In this paper, we aimed to summarize the measurement methods, current use in different clinical situations, strengths and limitations of the of P-wave dispersion.

The Effect of Synthetic Cannabinoids on P-Wave Dispersion: An Observational Study

OBJECTIVE

The aim of this study was to investigate the effect of synthetic cannabinoids (SC) on P-wave dispersion (PD) in patients who consume SC.

MATERIALS AND METHODS

The study population included 72 patients who consumed SC and 36 age- and sex-matched healthy controls. The severity of addiction was detected using the addiction profile index (BAPI). The PD was measured by 12-lead ECG obtained upon admission to hospital. Statistical analyses were performed using the SPSS v20.0 statistical software package.

RESULTS

The mean age of the patients and controls was 26.9 ± 7.0 and 26.3 ± 6.5 years, respectively. Mean duration of SC consumption was 1.7 ± 0.7 years. Mean BAPI score of patients who consumed SC was 12.8 ± 3.4. Patients who consumed SC had a significantly higher PD value than controls (37.7 ± 11.5 vs. 30.6 ± 6.4 ms, p < 0.001). The BAPI score was significantly correlated with PD value (r = 0.675, p < 0.001). In the linear regression model that included PD value, age and heart rate, PD value was significantly and independently correlated with BAPI score (r2 of the model = 0.339; p < 0.001).

CONCLUSIONS

In this study, patients who consumed SC had significantly higher PD values than controls, and the BAPI score correlated with the PD value. Hence SC consumption could lead to an increased risk of cardiovascular disease through prolonged PD. We recommend the use of the simple and inexpensive ECG to assess cardiovascular risk in patients who consume SC.

Infliximab, an anti-TNF-alpha agent, improves left atrial abnormalities in patients with rheumatoid arthritis: preliminary results

Background

Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality. In the current prospective study, we addressed the impact of RA on left atrial (LA) function and electrical remodelling. Further, we tried to demonstrate the effects of infliximab, an anti-TNFalpha agent, on echocardiographical LA abnormality in RA patients with preserved left ventricular (LV) ejection fraction.

Methods

We compared 38 female RA patients without clinical evidence of heart disease and 30 female controls without RA and clinical evidence of heart disease. Further, we compared RA patients receiving infliximab and increasing doses of prednisolone over a three-month period. At baseline and post treatment, this study assessed (1) LA and LV parameters using conventional and speckle tracking echocardiography (STE), and (2) electrocardiographic P-wave changes.

Results

The values of C-reactive protein (CRP), isovolumic relaxation time (IVRT), A wave, and deceleration time (DT) were significantly higher in RA patients compared to the control group (p < 0.05), whereas E/E′ and E/A values were found to be lower (p < 0.05) in RA patients. E/E′ values were lower in prednisolone- compared to infliximab-treated patients (p < 0.05). After three months of infliximab and prednisolone treatment, CRP and disease activity score (DAS 28) values decreased in both groups (p < 0.05), and Duke activity status index (DASI) increased (p < 0.05). Maximal left atrial volume index (LAVI_max), pre-contraction left atrial volume index (LAVI_preA) and maximum P wave (P_max) of the RA patients were higher compared to the control group (p < 0.05), whereas LA global strain was found to be lower (p < 0.05). There was no difference in P_max values between groups before and after the treatment period. E/E′, LAVI_max and LAVI_preA values of infliximab-treated patients decreased and LA global strain increased after three months of therapy compared to baseline (p < 0.05). At baseline in both treatment groups, E/E′ and LA global late diastolic strain rate were lower in prednisolone-compared to infliximab-treated patients (p < 0.05).

Conclusion

There was echocardiographic LA abnormality in these RA patients. In this patient group there was also a meaningful increase in maximum P wave assessed by electrocardiography. Infliximab therapy for a period of three months improved LA abnormality.

P-wave dispersion and its relationship with the severity of the disease in patients with stable coronary artery disease

OBJECTIVE:

P- wave dispersion (PD) is an indicator of inhomogeneous and discontinuous propagation of sinus impulses. In the present study we aimed to investigate the PD and its association with the severity of the disease. in patients with stable coronary artery disease.

METHODS:

We prospectively analyzed 60 subjects with coronary artery disease (CAD) and 25 subjects with nor-mal coronary angiograms (control group). The maximum and minimum P-wave duration and PD were measured from the 12-lead surface electrocardiograms. The CAD severity was assessed by the severity score (Gensini score) and the number of vessels involved (vessel score).

RESULTS:

P max was longer in CAD group compared with the control group (p<0.001). PD was greater in the CAD group, compared with the control group (p<0.001). However, P min did not differ between the two groups. In bi-variate correlation, increased PD was correlated with presence of diabetes mellitus (r=0.316, p=0.014), smoking (r=0.348, p=0.006), left ventricular ejection fraction (r=-0.372, p=0.003), vessel score (r=0.848, p=0.001), and Gensini score (r=0.825, p=0.001). Multiple linear regression analysis showed that PD was independently associ¬ated with vessel score ((3=0.139, p=0.002) and Gensini score ((3=0.132, p=0.007).

CONCLUSION:

PD was greater in patients with CAD than in controls and it was associated with CAD severity.

Factors to predict recurrence of atrial fibrillation in patients with hypertension

BACKGROUND

Patients with essential hypertension had a higher recurrence rate of atrial fibrillation (AF) than patients without hypertension. This study evaluated the role of various parameters for predicting recurrence after conversion of AF in patients with essential hypertension.

METHODS

We retrospectively analyzed 136 patients with essential hypertension and a known history of AF. P-wave duration and dispersion were measured in a 12-lead electrocardiograph. The size and function of the left atrium (LA) and left atrial appendage (LAA) were assessed by transthoracic and transesophageal echocardiography. The time interval from initiation of P-wave to the start of LAA ejection flow (P-LAA) was measured at the same time. All the patients were followed up for a period of 12 +/- 6 months for the recurrence of AF.

RESULTS

In the follow-up period, 38.2%of patients underwent AF recurrence. Age, P-LAA, P(max), P-wave dispersion, left atrium diameter (LAD), and maximum and minimum LAA volume were significantly higher in patients with AF recurrence than in patients without AF recurrence, while EF-LAA and LAA peak emptying velocity were much lower in patients with AF recurrence. P-LAA had positive correlation with LAD and P-wave dispersion (r = 0.501, p < 0.0001; r = 0.713, p < 0.0001).

CONCLUSION

These results indicated that increased P-wave dispersion, P-LAA in addition to the dilated LA, and the depressed LAA function may be useful to identify patients with hypertension at risk of recurrent AF.

P-wave dispersion increases in prehypertension

BACKGROUND

Prolongation of P-wave durations and increased P-wave dispersion are independent predictors of atrial fibrillation (AF). AF is the most common arrhythmia of the general population. Prehypertension, including those with systolic blood pressure ranging from 120-139 mmHg or diastolic blood pressure ranging from 80-89 mmHg was described by JNC7. Prehypertension is the predictor of development of hypertension in the future. Prehypertension is associated with excess cardiovascular morbidity and mortality. In this study, we evaluated relationship between prehypertension and P-wave dispersion.

METHODS

Seventy-eight prehypertensive patients (group 1: mean age 44.6+/-11.2 years; 45 male) and 78 normotensive patients (group 2: mean age 43.3+/-7.0 years; 43 male) were enrolled in this study. Standard 12-lead ECGs were recorded in all patients using a paper speed of 50 mm/s. In all patients, transthoracic echocardiographic examination was performed.

RESULTS

Pmax and P-wave dispersion were significantly higher in group 1 compared with group 2 (103.59+/-19.8 ms vs 93.59+/-13.4 ms, p<0.001; 50.51+/-18.6 ms vs 39.85+/-10.6 ms, p<0.001, respectively).

CONCLUSION

Pmax and P-wave dispersion increase in prehypertensive patients compared with normotensive patients. This data might show increased risk of AF in prehypertension.

Effect of treadmill exercise testing on P wave duration and dispersion in patients with isolated myocardial bridging

Several previous studies suggest that myocardial bridging (MB) is associated with ischemia and rhythm disturbances. We sought to examine exercise-induced changes in P wave duration and dispersion (PWD), the markers of atrial conduction abnormalities in patients with isolated MB of left anterior descending artery (LAD) and control subjects. Eighteen patients with MB of LAD (group-I) and 22 subjects with angiographically demonstrated normal coronary arteries (group-II) underwent treadmill exercise testing. Before and after exercise ECG was recorded at a paper speed of 50 mm/s. The change in maximum and minimum P wave duration was measured manually and difference between two values was defined as PWD. There was no difference between two groups in terms of demographic properties. Baseline maximum and minimum P wave duration and PWD durations were similar in both groups and they did not change after exercise. (Group-I: before and after test; 114 +/- 10 vs. 114 +/- 9, 66 +/- 13 vs. 67 +/- 10, and 47 +/- 9 vs. 45 +/- 13 ms, P > 0.05, group-II; 113 +/- 9 vs. 115 +/- 8, 68 +/- 11 vs. 68 +/- 11, 45 +/- 11 vs. 48 +/- 15 ms for each, respectively). In addition there was no significant correlation between PWD and P wave duration and echocardiographic variables. In patients with MB of LAD, PWD and P wave duration were not different than healthy subjects and treadmill exercise testing did not induce atrial conduction abnormalities in both groups.

The effect of rapid blood pressure control on P-wave dispersion in hypertensive urgency

INTRODUCTION

A sharp increase in blood pressure, increase in atrial pressure and atrial strain, left ventricular diastolic dysfunction, and left ventricular hypertrophy (LVH) lead to heterogeneity and instability in atrial conduction. The resulting physiopathological situation may elevate maximum Pwave duration (P(max)) and P-wave dispersion (PWD) in electrocardiography. The objective of our study was to explore the effect of the sudden change in atrial hemodynamics on P(max) and PWD, which may indicate the risk of atrial fibrillation (AF) development in hypertensive urgency.

METHODS

The study included patients diagnosed as hypertensive urgency (systolic blood pressure > or =180 mmHg, diastolic blood pressure > or =110 mmHg). Nitroprusside was started at a dose of 0.2 microg/kg/min, and the ensuing dose was arranged according to blood pressure. Echocardiography and electrocardiography were used to noninvasively measure changes in diastolic function and PWD and P(max), respectively.

RESULTS

The study enrolled 102 patients (mean age 57.9+/-11.6 years; 32 [31.4%] males, and 70 [68.6%] females). P(max) decreased from 99.9+/-11.1 msec (95% confidence intervals [CI] 97.7, 102) to 88.5+/-9.3 msec (95% CI 86.6, 90.3) (P<0.001), while PWD decreased from 60.1+/-7.4 msec (95% CI 58.7, 61.6) to 43.9+/-6.7 msec (95% CI 42.5, 45.2) (P<0.001). In addition, most patients had LVH and diastolic dysfunction. After nitroprusside treatment improvements in indicators of diastolic functions such as E/A ratio, deceleration time, and isovolumetric relaxation time were observed.

CONCLUSION

The change observed in P(max) and PWD in hypertensive urgency may be associated with the rapid change in blood pressure and atrial strain, sympathetic nervous system activation, relative myocardial ischemia, and left ventricular diastolic dysfunction. Rapid regulation of blood pressure with nitroprusside brought about a marked decrease in P(max) and PWD in our patients. This improvement was interpreted as atrial conduction acquiring a stable and homogeneous character, which may reduce the risk of AF development in hypertensive urgency.

Use of the TIMI frame count in the assessment of coronary artery blood flow and microvascular function over the past 15 years

Since its introduction, the TIMI frame count method has contributed to the understanding of the pathophysiology of coronary artery disease. In this article, the evolution of the TFC method and its applicability in the assessment of various therapeutic modalities are described.

Assessment of P-wave duration and dispersion in patients with isolated coronary artery ectasia

INTRODUCTION

Coronary artery ectasia (CAE) is defined as localized or diffuse dilatation of the epicardial coronary arteries. We sought to determine whether isolated CAE may alter P-wave duration and dispersion (PD).

METHODS

The study population consisted of 26 patients (mean age: 61.6+/-11.0 years) with isolated CAE (group 1) and sex- and age-matched 26 control subjects (group 2). Both groups underwent a standard 12-lead surface electrocardiogram recorded at 50 mm/s. Maximal (P(max)) and minimal P-wave durations (P(min)) are measured. PD was defined as the difference between P(max) and P(min).

RESULTS

In group 1, P(max) (114.2+/-10.4 ms vs 104.8+/-10.6 ms, p<0.002) and PD (34.0+/-12.7 ms vs 24+/-10.6, p<0.004) were significantly higher than those of group 2. Moreover a significant correlation was found between P(max) and PD with ectatic segment number (r=0.625, r=0.626, respectively; p=<0.001); and P(max) and PD with ectatic vessel number (r=0.698, r=0.704 respectively; p=<0.0001).

CONCLUSION

Isolated CAE and the degree of the ectasia were found to be associated with prolonged P(max) and PD.

The increase in P-wave dispersion is associated with the duration of disease in patients with Behçet's disease

AIM

P-wave dispersion (PD) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. Behçet's disease (BD) is a chronic multi-system disease presenting with recurrent oral and genital ulceration, and relapsing uveitis. Left ventricular diastolic dysfunction, ventricular arrhythmia and sudden cardiac death have been documented in Behçet's disease. The aim of this study was to evaluate myocardial involvement noninvasively in patients with BD by measuring PD.

METHODS

Study population included 29 patients with BD (group I), (16 males, mean age: 60.4+/-10.1 years), and 45 normal (group II), (23 males, mean age: 61.2+/-12.0 years). The maximum and minimum P-wave duration (Pmax and Pmin) and PD were measured from the 12-lead surface electrocardiogram. Echocardiographic examination was also performed.

RESULTS

There was no statistically significant difference between two groups in respect to age, gender, hypertension, diabetes mellitus, hyperlipidemia and cigarette smoking (p>0.05). Pmax and PD of patients with BD were found to be significantly higher than those of control subjects (116.2+/-14.0 ms vs. 102.0+/-16.5 and 49.3+/-12.7 ms vs. 29.3+/-8.5 ms, respectively p<0.0001). Moreover, we found a significant positive correlation between PD with BD duration (r=0.78, p<0.0001).

CONCLUSION

Pmax and PD are found to be greater in patients with BD than in controls and are related with the duration of the disease.

P wave dispersion is prolonged in patients with Wilson’s disease

AIM: To investigate the P wave dispersion as a non-invasive marker of intra-atrial conduction disturbances in patients with Wilson’s disease.

METHODS: We compared Wilson’s disease patients (n = 18) with age matched healthy subjects (n = 15) as controls. The diagnosis was based on clinical symptoms, laboratory tests (ceruloplasmin, urinary and hepatic copper concentrations). P wave dispersion, a measurement of the heterogeneity of atrial depolarization, was measured as the difference between the duration of the longest and the shortest P-waves in 12 lead electrocardiography.

RESULTS: All the patients were asymptomatic on cardiological examination and have sinusal rhythm in electrocardiography. Left ventricular and left atrial diameters, left ventricular ejection fraction and left ventricular mass index were similar in both groups. The Wilson’s disease patients had a significantly higher P wave dispersion compared with the controls (44.7 ± 5.8 vs 25.7 ± 2.5, P < 0.01).

CONCLUSION: There was an increase in P wave dispersion in cardiologically asymptomatic Wilson’s disease patients which probably represents an early stage of cardiac involvement.

Quantitative estimation of left atrial linear dimension on a transthoracic echocardiogram using an electrocardiographic formulaic assessment

A proportionate and incremental association between left atrial (LA) dilatation on a transthoracic echocardiogram (TTE) and increasing severity in abnormal atrial depolarization can be described by the regression formula: LA dimension in parasternal long-axis view (in millimeters) = 2.47 + 0.29 [P-wave duration (in milliseconds)]. However, prospective testing of this formula for LA quantification with comparison to other TTE indexes is lacking. We prospectively obtained 12-lead electrocardiograms for 72 consecutive patients before individual, nonemergent TTE assessment. P waves were assessed independently to the nearest 10 ms for application of the formula with a Bland-Altman plot. P-wave durations were obtained specifically from lead II and also from any lead that yielded the widest measurement. There was a strong formulaic correlation with LA measurement by TTE (p <0.00000001; r = 0.662), irrespective of electrocardiographic lead used. However, as the measurement difference increased between that in any lead and lead II, correlation strength increased. Correlation was not significantly affected by commonly measured electrocardiographic and TTE indexes, such as, PR interval, QRS complex, and left ventricular end-diastolic as well as systolic dimensions, after adjustment for these variables. Moreover, when the P-wave axis remained within the normal range, the correlation strength increased. The Bland-Altman plot also showed good agreement of LA dimension assessment between formulaic estimation and TTE measurement. In conclusion, there is good agreement and correlation between formulaic estimation and that of TTE for measurement of LA linear dimension. The LA regression formula is an indirect asset that could perhaps supplement LA quantification on TTE in certain circumstances.

Predictors of atrial fibrillation after coronary artery bypass surgery

OBJECTIVE

Atrial fibrillation is one of the most common arrhythmias associated with not only increased morbidity after coronary artery bypass grafting but also increased healthcare costs. Many factors are associated with atrial fibrillation onset after coronary artery bypass grafting. We prospectively examined which factors could predict atrial fibrillation after coronary artery bypass grafting.

METHODS

Fifty-seven consecutive patients (37 men, mean age=60.2+/-12 years) with sinus rhythm before coronary artery bypass grafting are included the study. Clinical, demographic, laboratory and echocardiographic characteristics are all evaluated prospectively. The maximum and minimum P-wave duration (P(max) and P(min)) were measured from the 12-lead surface electrocardiogram. The difference between the P(max) and the P(min) was calculated and defined as P-wave dispersion. Preoperative venous blood samples were taken for N-terminal proBrain natriuretic peptide level analysis.

RESULTS

Ten (17%) patients had postoperative atrial fibrillation. Patients with postoperative atrial fibrillation were older (69.4+/-6 versus 58.2+/-12 years, P=0.01), had lower ejection fraction (44.1+/-8.9% versus 54.3+/-9; P=0.002), higher proBrain natriuretic peptide levels (538+/-136 pg/ml versus 293+/-359 pg/ml; P=0.03), longer P(max) (142.2+/-13.7 ms versus 120.8+/-21.2 ms; P=0.006) and longer P-wave dispersion (55.0+/-8.2 ms versus 41.3+/-14.3 ms; P=0.008) compared with the patients without atrial fibrillation. Univariate analysis showed that increased age (P=0.01), lower ejection fraction (P=0.02), enlargement of left atrium (P=0.02), increased P(max) (P=0.006) and increased P-wave dispersion (P=0.008) and increased level of preoperative proBrain natriuretic peptide (P=0.03) were associated with postoperative atrial fibrillation. Positive correlation was seen between the age and level of proBrain natriuretic peptide (r=0.322 and P=0.015). In multivariate analysis, age (P=0.05), lower ejection fraction (P=0.03), left atrial enlargement (P=0.05), longer P(max) (P=0.01) and P-wave dispersion (P=0.01) were found to be independent predictors of postoperative atrial fibrillation.

CONCLUSION

Age, poor left ventricular functions, P(max) and P-wave dispersion are found to be independent predictors of atrial fibrillation after coronary artery bypass grafting.

Association of P-wave duration, dispersion, and terminal force in relation to P-wave axis among outpatients

BACKGROUND

While P-wave duration (P-dur) and dispersion (P-disp) could both reflect fractionated and inhomogeneous propagation of sinus cardiac impulses, and may therefore be associated with each other, a clear relationship has not been extensively studied. We studied these markers as well as the significance of P-wave terminal force in lead V1 (PTFV1) in relation to the P-wave axis (P-axis).

METHODS

We appraised our previously studied sample of 500 consecutively numbered, otherwise unselected, electrocardiograms (ECGs) of outpatients from the University of Massachusetts, Worcester, Massachusetts, for the foregoing P-wave characteristics. P-disp, defined as the difference of the duration between the widest and narrowest P wave, and the greatest P-dur after a 12-lead ECG search, was measured manually to the nearest 10 ms. PTFV1 was considered positive when > or = 40 mm2 terminal deflection was present on biphasic P waves on lead V1. Normal P-axis was considered 0 degrees to +75 degrees by manually constructing the mean frontal plane electrical P-axis from standard limb leads.

RESULTS

After excluding those with atrial arrhythmias, paced rhythms, errors in lead placement, P waves with low amplitude or overall technically poor tracing, 428 ECGs formed our final sample. P-dur was strongly associated with P-disp (P < 0.0001), but the correlation remained weak (r = 0.42). Overall, P-dur was not significantly associated with P-axis but when divided into tertiles and quintiles, the significance was evident within the range of the normal P-axis, particularly 0 degrees to +60 degrees (P < 0.0001). In a subanalysis of 380 ECGs that had appreciable biphasic P waves on lead V1, PTFV1 was noted on 178 (47%) ECGs and was significantly associated with P-dur (P < 0.0001), P-disp (P < 0.0001), and P-axis (P = 002). When considering P-axis in tertiles and quintiles, P-dur was greater in patients with a positive PTFV1 and significant within the normal range of the P-axis, especially from 0 degrees to +60 degrees .

CONCLUSION

P-dur, P-disp, and PTFV1 appear to share a significant tripartite association in relation to the normal P-axis, particularly when P-axis ranges 0 degrees to +60 degrees . Therefore, for optimal clinical assessment, these markers should be evaluated in relation to the normal P-axis.

P wave dispersion in patients with rheumatoid arthritis: its relation with clinical and echocardiographic parameters

P wave dispersion (PWD) is a sign for the prediction of atrial fibrillation (AF). The aim of this study was to assess P wave dispersion and its relation with clinical and echocardiographic parameters in patients with rheumatoid arthritis (RA). Thirty RA patients (mean age 49 +/- 10 years) and 27 healthy controls (mean age 47 +/- 8 years) were included in the study. We performed electrocardiography and Doppler echocardiography on patients and controls. Maximum and minimum P wave duration were obtained from electrocardiographic measurements. PWD defined as the difference between maximum and minimum P wave duration was also calculated. Maximum P wave duration and PWD was higher in RA patients than controls (P = 0.031 and P = 0.001, respectively). However, there was no significant difference in minimum P wave duration between the two groups (P = 0.152). There was significant correlation between PWD and disease duration (r = 0.375, P = 0.009) and isovolumetric relaxation time (r = 0.390, P = 0.006). P wave duration and PWD was found to be higher in RA patients than healthy control subjects. PWD is closely associated with disease duration and left ventricular (LV) diastolic dysfunction.

Diurnal variation of the P-wave dispersion in chronic ischemic heart diseases

OBJECTIVE

Electrocardiographic indices like maximum P-wave duration (P(max)) and P-wave dispersion (PD) can be used to detect patients with atrial conduction disorders, myocardial ischemia and those at risk for atrial fibrillation. Considering the diurnal variation of ischemia in patients with significant coronary lesions, this study was designed to investigate the diurnal variation of eventual atrial conduction abnormalities.

METHODS

Forty-eight patients (31 male) with typical angina were grouped according to coronary angiography results as group 1 - 70% or more luminal reduction in at least one of the coronary arteries (n=28), and group 2 - normal coronary arteries (n=20). The difference between the P(max) and minimum P-wave durations (P(min)) is designated as PD. The diurnal P(max), P(min) and PD values were compared between and within the groups.

RESULTS

The morning P(max) value of group 1 was significantly higher than the value of group 2 (112+/-1 vs. 102+/-1 ms, P<0.001). The morning PD of group 1 was significantly higher than that of group 2 (54+/-9 vs. 48+/-1 ms, P<0.05). The morning P(max) of group 1 (112+/-1 ms) was significantly higher than its afternoon (102+/-9 ms) and night (102+/-1 ms) values (P<0.001). The morning PD of group 1 (54+/-9 ms) was higher than the afternoon (40+/-10 ms) and night (43+/-9 ms) PD (P<0.001). No significant difference was observed between the P(max), P(min) and PD values in group 2 (P>0.05).

CONCLUSION

This study demonstrated that coronary heart disease patients have higher morning P(max) and PD values that may be important regarding prediction of timing and treatment of atrial conduction disorders in myocardial ischemia.

Relation between P-wave dispersion and left ventricular geometric patterns in newly diagnosed essential hypertension

AIM

P-wave durations and P-wave dispersion (PD) are considered to reflect the heterogeneous conduction in atria. The aim of this study was to investigate PD and P-wave duration in different left ventricle geometric patterns of hypertensive patients.

METHODS

One hundred forty-nine consecutive patients with newly diagnosed essential hypertension and 29 healthy control groups were included in the study. The maximum and minimum P-wave duration (Pmax and Pmin, respectively) and PD were measured from the 12-lead surface electrocardiogram. Echocardiographic examination was also performed in all subjects. Four different geometric patterns were identified in hypertensive patients according to left ventricular mass index (LVMI) and relative wall thickness.

RESULTS

P-wave dispersion was longer in concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH) groups when compared with the control group (P = .009, P < .001, P < .001, respectively). P-wave dispersion of normal left ventricle (NLV) geometric pattern was not different from that of the control group. Patients with NLV geometric pattern had shorter PD than patients who had CH and EH (NLV vs CH, P < .001; NLV vs EH, P = .025). P-wave dispersion of the NLV group was not different from that of the CR group. Patients with CR had also shorter PD than patients who had CH (P = .002). In bivariate analysis, there was a significant correlation between PD with left ventricle geometry, body surface area, LVMI, and relative wall thickness. In multiple linear regression analysis, PD was independently correlated only with LVMI (beta = .425, P < .001).

CONCLUSIONS

P-wave dispersion is independently associated with LVMI rather than left ventricle geometry and relative wall thickness in hypertensive patients. Thus, it is increased particularly in patients with CH and EH.

P-wave duration and dispersion in patients with coronary slow flow and its relationship with Thrombolysis in Myocardial Infarction frame count

AIM

P-wave dispersion (PD), and duration has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. The aim of this study was to investigate the PD in patients with coronary slow flow (CSF) phenomenon.

METHODS

Study population included 48 patients with angiographically proven normal coronary arteries and slow coronary flow in all 3 coronary vessels (group I, 36 men; mean age, 54 +/- 9 years) and 32 subjects with angiographically proven normal coronary arteries without associated slow coronary flow (group II, 24 men, mean age, 53 +/- 10 years). Coronary flow rates of all patients and control subjects were documented by Thrombolysis In Myocardial Infarction (TIMI) frame count. All patients in group I had TIMI frame counts greater than 2 SD above those of control subjects (group II). The mean TIMI frame count for each patient and control subject was calculated by adding the TIMI frame counts for each major epicardial coronary artery and then dividing the obtained value into 3. The maximum and minimum P-wave duration (P(max) and P(min)) and PD were measured from the 12-lead surface electrocardiogram. Echocardiographic examination was also performed.

RESULTS

There was no statistically significant difference between the 2 groups with respect to age, sex, hypertension, diabetes mellitus, hyperlipidemia, and cigarette smoking (P > .05). P-wave dispersion and P(max) of patients with CSF were found to be significantly higher than those of control subjects (39.4 +/- 17 vs 21.2 +/- 10 milliseconds and 121.6 +/- 17.1 vs 104.3 +/- 10.4 milliseconds, respectively; P < .0001). Moreover, we found a significant positive correlation between both P(max) and PD with mean TIMI frame count (r = 0.836 and r = 0.806, respectively; P < .0001).

CONCLUSIONS

P-wave dispersion and P-wave duration both were found to be greater in patients with CSF than in controls.

Potential clinical correlates and risk factors for interatrial block

BACKGROUND

Interatrial block (IAB; P wave > or =110 ms) denotes a conduction delay between the atria, is strongly associated with atrial tachyarrhythmias, left atrial enlargement, left atrial electromechanical dysfunction, and is a risk for embolism. Despite this, potential risk factors for IAB have not been clearly defined.

METHODS

Patients admitted via the Emergency Department for nonacute medical reasons to the nontelemetry general medical floors of a tertiary care general hospital from October to November 2004 were screened for sinus rhythm on electrocardiograms. Four hundred and four patients who met our criteria were then evaluated for IAB on respective electrocardiograms. All patients were subsequently compared for common diseases as well as coronary artery disease (CAD) risk factors and divided into two groups, those with IAB and those without (control). Mean age +/- standard deviation, odds ratios (ORs), 95% confidence intervals (CIs), r values, and p values were calculated. p values <0.05 were considered statistically significant.

RESULTS

From the sample (n = 404), 182 patients had IAB (45%; mean age 64.32 +/- 19.27 years; males 51.6%) while 222 did not (control). CAD (OR 3.150, 95% CI 2.05-4.83; p < 0.001, r = 0.3), hypertension (OR 2.918, 95% CI 1.85-4.60; p < 0.001, r = 0.2), diabetes mellitus (OR 2.542, 95% CI 1.62-3.97; p < 0.001, r = 0.1), and hypercholesterolemia (OR 1.823, 95% CI 1.22-2.74; p = 0.004, r = 0.2) were significant risk factors and correlates for IAB. Multivariate analysis using stepwise linear regression revealed these factors as direct correlates of IAB.

CONCLUSION

CAD, hypertension, diabetes mellitus and hypercholesterolemia appear to be risk factors for IAB in general hospital patients admitted for nonacute reasons. Considering the known sequelae of IAB, awareness of its associations with such risk factors could be important for patient risk stratification.