Comparison of atrial electromechanical coupling interval and P-wave dispersion in non-dipper versus dipper hypertensive subjects

Cardiac electrical and structural alterations in preeclampsia

BACKGROUND

Preeclampsia increases the risk of cardiovascular mortality and morbidity both during pregnancy and long term after the labor by causing cardiac changes that may lead to atrial and ventricular arrhythmias.

OBJECTIVE

We aimed to investigate noninvasive predictors of atrial and ventricular arrhythmias and cardiac structural changes in preeclampsia.

METHODS

The study included 34 preeclampsia patients as the study group and 33 healthy pregnant women as the control group. The presence of fragmented QRS morphology, P dispersion, QT dispersion, Tp-e/QTc ratio, inter- and intra-atrial electromechanical delay, left ventricular mass index was evaluated in the groups by 12 lead- ECG and standard and tissue Doppler echocardiography.

RESULTS

Left ventricular mass index and relative wall thickness, and E/Em ratio was significantly higher in preeclampsia. Inter- and intra-atrial electromechanical delay and Tp-e were prolonged, and P dispersion, QT dispersion, and Tp-e/QTc ratio were increased significantly in patients with preeclampsia. In addition, fragmented QRS morphology was seen in 76.5% of patients with preeclampsia while it was present in only 27.3% of the control group (p < .001).

CONCLUSION

Preeclampsia causes significant cardiac structural and electrocardiographic alterations that may increase the risk of atrial and/or ventricular arrhythmias. A more thorough and earlier cardiac assessment and closer follow-up of these patients would be useful to avoid further complications.

Assessment of Hypertension Using Clinical Electrocardiogram Features: A First-Ever Review

Hypertension affects an estimated 1.4 billion people and is a major cause of morbidity and mortality worldwide. Early diagnosis and intervention can potentially decrease cardiovascular events later in life. However, blood pressure (BP) measurements take time and require training for health care professionals. The measurements are also inconvenient for patients to access, numerous daily variables affect BP values, and only a few BP readings can be collected per session. This leads to an unmet need for an accurate, 24-h continuous, and portable BP measurement system. Electrocardiograms (ECGs) have been considered as an alternative way to measure BP and may meet this need. This review summarizes the literature published from January 1, 2010, to January 1, 2020, on the use of only ECG wave morphology to monitor BP or identify hypertension. From 35 articles analyzed (9 of those with no listed comorbidities and confounders), the P wave, QTc intervals and TpTe intervals may be promising for this purpose. Unfortunately, with the limited number of articles and the variety of participant populations, we are unable to make conclusions about the effectiveness of ECG-only BP monitoring. We provide 13 recommendations for future ECG-only BP monitoring studies and highlight the limited findings in pregnant and pediatric populations. With the advent of convenient and portable ECG signal recording in smart devices and wearables such as watches, understanding how to apply ECG-only findings to identify hypertension early is crucial to improving health outcomes worldwide.

P-wave and QT dispersion in hypertensive disorders of pregnancy

Aim: To compare P-wave and QT dispersion values in hypertensive disorders of pregnancy and controls and also in preeclampsia, chronic hypertension, and gestational hypertension separately.Material and methods: We included 140 hypertensive pregnants and 110 healthy age-matched pregnants in this study. The hypertensive pregnants were divided into three subgroups: preeclampsia (n = 43), chronic hypertension (n = 51), and gestational hypertension (n = 46). P-wave and QT dispersion values were compared between groups.Results: Hypertensive pregnants had higher P-wave (41.74 ± 5.51 vs. 37.73 ± 5.62, p < .001) and QTc dispersion (45.44 ± 7.62 vs. 39.77 ± 8.34, p < .001) values. In subgroup analysis, P-wave dispersion and QTc dispersion were different between preeclamptic, chronic hypertensive, and gestational hypertensive patients. Also, they were significantly higher in chronic hypertension as compared to gestational hypertension and they were higher in preeclampsia than in gestational hypertension. No difference was found according to these parameters between preeclampsia and chronic hypertension. In correlation analysis, both P-wave dispersion and QTc dispersion were positively correlated with systolic (r = 0.409, p < .001 and r = 0.306, p < .001) and diastolic blood pressure (r = 0.390, p < .001 and r = 0.287, p < .001) which are main clinical determinants of hypertensive disorders.Conclusion: In clinical practice, chronic hypertensive pregnants are generally followed up in their future life for cardiovascular disorders. Also, we recommend that we must inform and follow preeclamptic patients for future cardiovascular diseases.

P-Wave Dispersion and Atrial Electromechanical Delay in Patients with Preeclampsia

OBJECTIVES

To investigate the duration of atrial electromechanical delay (EMD) and left atrial mechanical function in patients with preeclampsia.

MATERIALS AND METHODS

This study included 26 pregnant women with preeclampsia and 24 age-matched pregnant women without preeclampsia (control group). Atrial electromechanical coupling (PA) and intra-atrial and interatrial EMD were measured using tissue Doppler echocardiography. P-wave dispersion (PWD) was measured via 12-lead electrocardiography. All data were analyzed using SPSS v.15.0 for Windows (SPSS, Inc., Chicago, Ill., USA). Differences in continuous variables between groups were examined using a nonparametric Mann-Whitney U test. Correlation analysis was performed using Spearman's coefficient of correlation. Categorical values were compared using a χ2 test.

RESULTS

PA lateral and PA septal durations were significantly longer in the preeclampsia group than in the control group [74.6 ± 8.1 vs. 62.3 ± 5.3 ms (p < 0.001) and 59.7 ± 5.3 vs. 56.2 ± 4.9 ms (p = 0.005), respectively]. The duration of interatrial EMD and intra-atrial EMD in the preeclampsia group was significantly longer than in the control group [25.4 ± 4.6 vs. 13.2 ± 3.9 ms (p < 0.001) and 10.5 ± 1.9 vs. 7.1 ± 1.2 ms (p < 0.001), respectively]. PWD was significantly higher in patients with preeclampsia (43.1 ± 9.1 ms) than in the controls (37.6 ± 7.9 ms; p = 0.008). There was a significant correlation between PWD and interatrial EMD and intra-atrial EMD [r = 0.46 (p < 0.001) and r = 0.39 (p < 0.001), respectively].

CONCLUSION

The duration of atrial EMD and PWD was prolonged in patients with preeclampsia.

Atrial conduction delay predicts atrial fibrillation in paroxysmal supraventricular tachycardia patients after radiofrequency catheter ablation

This study aimed to assess whether intra- and inter-atrial conduction delay could predict atrial fibrillation (AF) for paroxysmal supraventricular tachycardia (PSVT) patients after successful treatment by radiofrequency catheter ablation (RFCA). Echocardiography examination was performed on 524 consecutive PSVT patients (15 patients were excluded). Left atrial dimension, right atrial diameter and intra- and inter-atrial conduction delay were measured before ablation. Patients were divided into group A (n = 32): occurrence of AF after the ablation and group B (n = 477): remained in sinus rhythm during follow-up. Receiver operating characteristic (ROC) curve analysis was performed to estimate the predictive value of intra- and inter-atrial conduction delay. Both intra- and inter-atrial conduction delay were higher in group A than in group B (4.79 ± 0.30 msec vs. 4.56 ± 0.32 msec; 21.98 ± 1.32 msec vs. 20.01 ± 1.33; p < 0.05). Binary logistic regression analysis showed that intra- and inter-atrial conduction were significant influential factors for the occurrence of AF (odds ratio [OR] = 13.577, 95% confidence interval [CI], 3.469-48.914; OR = 2.569, 95% CI, 1.909-3.459, p < 0.05). The ROC cure analysis revealed that intra-atrial conduction delay ≥ 4.45 msec and inter-atrial conduction delay ≥ 20.65 were the most optimal cut-off value for predicting AF in PSVT patients after RFCA. In conclusion, this is the first study to show that the intra- and inter-atrial conduction delay could effectively predict AF in post-ablation PSVT patients.

Atrial electromechanical coupling interval and P-wave dispersion in healthy elderly

BACKGROUND AND AIMS

The aim of our study was to investigate the potential effect of natural aging on atrial fibrillation (AF) by means of electrocardiographic P-wave analysis and measurement of the transthoracic echocardiographic electromechanical coupling interval (EMC).

METHODS

The study comprised 25 healthy individuals aged ≥65 years (group 1) and 25 control subjects <65 years (group 2). The difference between maximum (Pmax) and minimum (Pmin) P-wave durations on 12-lead electrocardiography were defined as P-wave dispersion (PD). Intra- and inter-atrial EMC were measured by tissue Doppler imaging.

RESULTS

Pmax (107.2 ± 3.58 msec vs 100.0 ± 3.56 msec, p<0.001) and PD (43.6 ± 4.98 msec vs 36.5 ± 3.56 msec, p<0.001) were significantly higher in group 1 than in group 2. Left atrial EMC [24.6 (15.20) vs 13.3 (4.50), p<0.001] and inter-atrial EMC [43.2 (16.05) vs 33.3 (4.75), p<0.001] were significantly delayed in group 1 compared with group 2. There was a significant correlation between left atrial diameter, PD, Pmax, left atrial EMC, and inter-atrial EMC.

CONCLUSION

Aging is correlated with increased left atrial size and impaired diastolic relaxation, which may contribute to a greater risk of AF in terms of prolonged PD and atrial EMC.

Atrial electromechanical coupling interval and P-wave dispersion in patients with white coat hypertension

BACKGROUND

The aim of our study was to investigate the effect of white coat hypertension (WCH) to atrial conduction abnormalities by electrocardiographic P-wave analysis and echocardiographic electromechanical coupling (EMC) interval measurement.

METHODS

The study consisted of sex-, age-, and body mass index-matched 24 patients with WCH, 24 patients with sustained hypertension (SH), and 24 subjects with normotension (NT). The difference between the maximum (Pmax) and minimum P-wave durations on 12-lead electrocardiography was defined as P-wave dispersion (PD). Intra- and inter-atrial EMC were measured by tissue Doppler imaging.

RESULTS

Pmax and PD of subjects with WCH were significantly higher than those of normotensives and lower than those of patients with SH. Inter-atrial EMC and left atrial EMC values of WCH group were intermediate between NT and SH groups. There was a significant correlation between left atrial diameter, PD, Pmax, left ventricle mass index, left atrial EMC, and inter-atrial EMC.

CONCLUSION

White coat hypertension is an intermediate group between SH and NT in terms of atrial electromechanical abnormalities which may be associated with the risk of atrial fibrillation.

Evaluation of the Relationship between Circadian Blood Pressure Variation and Left Atrial Function Using Strain Imaging

Background

Non-dippers were reported as showing different left atrial function, compared to dippers, but no study to date investigated the changes in the left atrial function according to the diurnal blood pressure pattern, using tissue Doppler and strain imaging.

Methods

Forty never treated hypertensive patients between 30 and 80 years of age were enrolled in this study. Patients were classified as non-dippers when, during night time, they had a blood pressure decrease of less than 10%. Strain of the left atrium was measured during late systole, and peak strain rates of the left atrium were measured during systole, early and late diastolic periods.

Results

The left atrial expansion index, left atrial active emptying volume and left atrial active emptying fraction were all significantly increased in non-dippers. They also had increased values of mean peak left atrial strain (dippers = 21.26 ± 4.23% vs. non-dippers = 24.91 ± 5.20%, p = 0.02), strain rate during reservoir (dippers = 1.29 ± 0.23 s^-1 vs. non-dippers =1.52 ± 0.27 s^-1, p = 0.01) and contractile period (dippers = -1.38 ± 0.24 s^-1 vs. non-dippers = -1.68 ± 0.32 s^-1, p < 0.01).

Conclusion

Strain and strain rate acquired from color Doppler tissue imaging demonstrate exaggerated reservoir and booster pump function in never-treated, non-dipper hypertensive patients. These methods are simple and sensitive for the early detection of subtle changes in the left atrial function.