Assessment of electrocardiographic criteria of left atrial enlargement

Nocturia independently predicts left ventricular hypertrophy and left atrial enlargement among patients with cardiac symptoms

Nocturia can be caused by urological disorders and systemic diseases, including heart diseases. We aimed to investigate the relationship between nocturia and structural abnormalities on echocardiography. Adult patients who underwent echocardiography for cardiac symptoms or heart murmur or had a history of structural heart disease were included. The voiding times during sleep hours were collected prospectively. Univariate and multivariate analyses were performed to evaluate the predictive value of bothersome nocturia (nocturia ≥ 2) on echocardiographic abnormalities. Of 299 patients, 182 (60.9%) reported bothersome nocturia. In patients aged ≥ 65 years, hypertension and left atrial enlargement (LAE) were associated with higher occurrences of bothersome nocturia. On multivariate analysis, bothersome nocturia was a predictive factor of LAE (odds ratio [OR] 2.453, 95% confidence interval [CI] 1.363–4.416, p = 0.003). Moreover, bothersome nocturia could predict both LAE and left ventricular hypertrophy (LVH) (OR 2.285, 95% CI 1.151–4.536, p = 0.018; OR 2.056, 95% CI 1.025–4.124, p = 0.043) in the elderly. Older age, hypertension, and LAE were risk factors for bothersome nocturia. Moreover, bothersome nocturia was predictive of LAE and LVH in the elderly. Patients with bothersome nocturia without other significant lower urinary tract symptoms should be referred to cardiologists.

Evaluation of the association between electrocardiogram parameters and left cardiac remodeling in dogs with myxomatous mitral valve disease

Background and Aim: Electrocardiography (ECG) is an adjunct for cardiac enlargement diagnosis. However, its efficacy in assessing left cardiac remodeling (left atrial and left ventricular enlargement) in dogs with myxomatous mitral valve disease (MMVD) remains unclear. This study aimed to evaluate the association between ECG parameters and left cardiac remodeling and to investigate whether the rate of change in ECG waveforms in the same individual reflected left cardiac remodeling in dogs with MMVD. Materials and Methods: This retrospective study included 20 healthy dogs and 140 dogs with MMVD. Data on clinical variables were obtained through physical examination, thoracic radiography, and echocardiography. The ECG parameters were the P-wave duration, PR interval, QRS complex duration, P-wave amplitude, R-wave amplitude, and mean electrical axis. Dogs with examination data that could be obtained multiple times during the study period were classified into the non-progressive and progressive groups. Results: Only the P-wave and QRS complex durations were selected as significant variables associated with imaging test parameters (p < 0.05); they had a relatively higher discriminatory ability for the left cardiac remodeling than other ECG parameters. The rates of change in the PR interval and R-wave amplitude were significantly higher in the progressive group than in the non-progressive group. Conclusion: In dogs with MMVD, the P-wave and QRS complex durations were significantly correlated with the left cardiac remodeling indicators. Furthermore, an increased rate of change in the PR interval and R-wave amplitude in the same individual may indicate left cardiac remodeling.

Different associations between left atrial size and 2.5-year clinical outcomes in patients with anterior versus non-anterior wall ST-elevation myocardial infarction

Objective

To investigate associations between left atrial diameter (LAD) and long-term outcomes in patients with anterior or non-anterior wall ST-elevation myocardial infarction (STEMI).

Methods

Patients with STEMI were included in this secondary analysis of data from a prospective cohort study in which the primary outcome was major adverse cardiovascular event (MACE) occurrence during a 2.5-year follow-up. A LAD cut-off value was obtained through receiver operating characteristic curve analysis. Kaplan-Meier curve and Cox regression analyses were applied. Subgroup Cox regression analysis was also performed, with patients stratified based on left ventricular diastolic diameter (LVEDD, > 55 mm and ≤55 mm). The relationship between LAD and outcomes in patients with anterior or non-anterior wall STEMI was explored using restricted cubic spline functions.

Results

Out of 464 patients, adjusted Cox regression showed that dichotomous (>40 mm) LAD was significantly associated with MACE (hazard ratio 2.978, 95% confidence interval 1.763, 5.030) in patients with anterior wall but not non-anterior wall STEMI. The association was not different between normal and enlarged LVEDD groups.

Conclusions

A left atrium > 40 mm may indicate higher risk of MACE in patients with anterior wall STEMI, even in patients with normal left ventricular structure. This relationship was not observed in patients with non-anterior wall STEMI.

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

A prolonged P‐wave in electrocardiography (ECG) reflects atrial remodeling and predicts the development of atrial fibrillation (AF). The authors enrolled 810 subjects in the Japan Morning Surge Home Blood Pressure (J‐HOP) study who had ≥1 cardiovascular (CV) risk factor. The duration of P‐wave was automatically analyzed by standard 12‐lead electrocardiogram. Left atrial (LA) enlargement and left ventricular hypertrophy (LVH) were measured on echocardiography. The primary end points were fatal/nonfatal cardiac events: myocardial infarction, sudden death, and hospitalization for heart failure. The maximum P‐wave duration (Pmax) from the 12 leads was selected for analysis. The authors compared four prolonged P‐wave cutoffs (Pmax = 120, 130, 140, 150 ms) and cardiac events. LA diameter and left ventricular mass index (LVMI) were significantly associated with Pmax (r = 0.08, P = .02 and r = 0.17, P < .001, respectively). When the cutoff level was Pmax 120 or 130 ms, prolonged P‐wave was not associated with cardiac events (P = .45 and P = .10), but when a prolonged P‐wave was defined as Pmax ≥ 140 ms (n = 50) or Pmax ≥ 150 ms (n = 19), the patients in those groups had significantly higher incidence of cardiac events than others (P < .001 and P = .03). A Cox proportional hazards model including age, gender, body mass index, smoking, regular drinker, hypertension, dyslipidemia, diabetes, office systolic blood pressure, heart rate, LA enlargement, and LVH revealed that prolonged P‐wave defined as Pmax ≥ 140 ms was independently associated with cardiac events (hazard ratio: 4.23; 95% confidence interval: 1.30–13.77; P = .02). In conclusion, the automatically assessed prolonged P‐wave was associated with cardiac events independently of LA enlargement and LVH in Japanese patients with CV risks.

A predictive value of the dynamic changes of the P-wave terminal force in lead V1 in the long-term prognosis of patients with non-ST-segment elevation acute coronary syndrome

BACKGROUND

The purpose of this study was to investigate the prognostic value of dynamic changes of P-wave terminal force in lead V1 (PtfV1 ) at electrocardiogram (ECG) in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) during the long-term major adverse cardiovascular events (MACEs) of patients.

METHODS

According to the PtfV1 value, the patients were divided into four groups: PtfV1 (-)/PtfV1 (-), PtfV1 (-)/PtfV1 (+), PtfV1 (+)/PtfV1 (-), and PtfV1 (+)/PtfV1 (+).

RESULTS

The highest incidence of MACEs was the PtfV1 (-)/(+) group with 24 patients (24.7%). The lowest incidence was the PtfV1 (-)/(-) group with 28 patients (4.9%). Compared with the PtfV1 (-)/(-) group, the risk for the occurrence of MACEs in the PtfV1 (-)/(+)group was significantly increased (24.7% vs 4.9%, P = .000). Similarly, the risk in the PtfV1 (+)/(+) group was also increased (10.1% vs 4.9%, P = .000).

CONCLUSION

The persistence of PtfV1 (+) and conversion of PtfV1 /(-) to PtfV1 /(+) at discharge significantly increased the incidence of MACEs.

Accuracy of Electrocardiography and Agreement with Echocardiography in the Diagnosis of Pediatric Left Atrial Enlargement

Left atrial enlargement (LAE) is a marker for diastolic cardiac dysfunction. Echocardiograms are considered the gold-standard for diagnosis, but given their wider access and lower economic cost, electrocardiograms (ECGs) may be useful in identifying patients who would benefit from further investigation. This study investigates the utility of ECG criteria to diagnose LAE in pediatric patients. A retrospective chart review (n = 492) was conducted in patients whose echocardiograms demonstrated LAE by left atrial indexed diameter z-score ≥2.0 and/or increased left atrial to aortic root ratio at various cutoffs (≥1.4, ≥1.6, ≥1.8). ECG criteria studied included: (1) P wave ≥110 msec, (2) P mitrale ≥40 msec, in LII (3) terminal negative P wave deflection in lead V1 > 40 msec, and (4) P/PR segment >1.6 in lead II. Sensitivity, specificity, Cohen's Kappa coefficient (κ), and ROC curves were calculated. A combination of P mitrale ≥40 msec and terminal negative P wave deflection in lead V1 > 40 msec yielded the greatest agreement (κ = 0.221, 95%CI 0.060-0.382), but all ECG criteria used to diagnose LAE had poor diagnostic value (AUC < 0.60). The present ECG criteria should not be used to diagnose LAE in the absence of an echocardiogram and findings should be considered in the context of clinical symptoms.

New electrocardiographic score for the prediction of atrial fibrillation: The MVP ECG risk score (morphology-voltage-P-wave duration)

BACKGROUND

Atrial fibrillation (AF) is the most common arrhythmia and has significant morbidity. A score composed of easily measured electrocardiographic variables to identify patients at risk of AF would be of great value in order to stratify patients for increased monitoring and surveillance. The purpose of this study was to develop an electrocardiographic risk score for new-onset AF.

METHODS

A total of 676 patients without previous AF undergoing coronary angiography were retrospectively studied. Points were allocated based on P-wave morphology in inferior leads, voltage in lead 1, and P-wave duration (MVP). Patients were divided into three risk groups and followed until development of AF or last available clinical appointment.

RESULTS

Mean age was 65 years, and 68% were male. The high- and intermediate-risk groups were more likely to develop AF than the low-risk group (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3-4.4; p = 0.006 and OR 2.1, 95% CI 1.4-3.27; p = 0.009, respectively). The high-risk group had a significantly shorter mean time to development of AF (258 weeks; 95% CI 205-310 weeks) compared to the intermediate- (278 weeks; 95% CI 252-303 weeks) and low-risk groups (322 weeks 95% CI 307-338 weeks), p = 0.005.

CONCLUSIONS

A simple risk score composed of easy-to-measure electrocardiographic variables can help to predict new-onset AF. Further validation studies will be needed to assess the ability of this risk score to predict AF in other populations.