Yonsei Med J.  2007 Oct;48(5):810-817. 10.3349/ymj.2007.48.5.810.

The Relationship between the Left Atrial Volume and the Maximum P-wave and P-wave Dispersion in Patients with Congestive Heart Failure

• Kim DH
• Kim GC
• Kim SH
• Yu HK
• Choi WG
• An IS
• Kwan J
• Park KS
• Lee WH

• KMID: 1122619
• DOI: http://doi.org/10.3349/ymj.2007.48.5.810

Abstract

PURPOSE: A maximum P-wave duration (Pmax) of > or = 110msec and a P-wave dispersion (PWD) > or = 40msec are accepted indicators of a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse, respectively. The left atrial (LA) volume has been reported to be strongly associated with a systolic and diastolic dysfunction and is considered to be an index of atrial remodeling. We aimed to investigate the relationship between LA volume and Pmax or PWD in patients with congestive heart failure (CHF). PATIENTS AND METHODS: Sixty-one patients with CHF were enrolled in this study. The study population was classified into four groups: two groups were divided according to the Pmax (> or = 110msec or < 110ms), and the other two groups were formed based on the PWD (> or = 40msec or < 40msec). The left atrial volume index (LAVi) was measured by three-dimensional (3-D) transthoracic echocardiography. The Pmax and PWD were measured from a 12-lead electrocardiogram. RESULTS: There were significant differences in the ejection fraction (EF), diastolic function, and LAVi between patients with a Pmax > or = 110ms or a PWD > or = 40ms and those with a Pmax < 110ms or a PWD < 40ms. The LAVi was independently associated with a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse. The LAVi can be used to identify patients with a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse with reasonably good accuracy. CONCLUSION: We concluded that a disturbance in interatrial conduction and an inhomogenous propagation of the sinus impulse in patients with CHF is associated with an increase in the LA volume and a deleterious systolic and diastolic dysfunction.

Keyword

P-wave duration; P-wave dispersion; heart failure; left atrial volume

MeSH Terms

Aged
*Atrial Function, Left
*Cardiac Volume
Echocardiography
*Electrocardiography
Female
Heart Failure/*physiopathology/ultrasonography
Humans
Male
Middle Aged
Sinus Arrest, Cardiac/ultrasonography

Figure

• 

  Fig. 1 On the ROC curve, the AUC of the LAVi for predicting a disturbance in the interatrial conduction was 0.792 (sensitivity 78.0%, specificity 89.5%, positive predictive value 78.1%, negative predictive value 89.5%), and the optimum cut-off point was 48.03 mL/m2 (p < 0.0001). ROC, receiver operating characteristic; AUC, accuracy; LAVi, left atrial volume index.

• 

  Fig. 2 On the ROC curve, the AUC of LAVi for predicting an inhomogeneous propagation of the sinus impulse was 0.833 (sensitivity 80.6%, specificity 79.3%, positive predictive value 80.6%, negative predictive value 79.3%), and the optimum cut-off point was 49.80 mL/m2 (p < 0.0001). ROC, receiver operating characteristic; AUC, accuracy, LAVi, left atrial volume index.

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