Echocadiographic and Electrocardiographic Criteria for Diagnosing Left Atrial Enlargement

Termini, Benedict A.; Lee, Y C

doi:10.1097/00007611-197502000-00010

Cited by 19 publications

(6 citation statements)

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“…Prior studies of left atrial size as determined by echocardiography have related left atrial diameter to electrocardiographic criteria of left atrial "enlargement" [12,13,19,20]. In the present study patients with a left atrial dimension of 40 mm or more had a significantly higher frequency of one or more electrocardiographic criteria suggestive of left atrial enlargement (37.5% vs 15%, p<O.Ol).…”

Section: Echocardlographic and Electrocardiographic Correlative Studiessupporting

confidence: 50%

“…Twelve lead electrocardiograms, taken on all patients, were reviewed by the authors and a diagnosis of left atrial abnormality was made on the basis of a combination of several, but not necessarily all of the following electrocardiographic findings: P wave duration in lead I1 equal to or greater than 0.12 seconds with or without notching, a ratio of the duration of the negative terminal P wave to the P-R segment in V, equal to or greater than 1 .O, and the product of the duration of the negative terminal P wave force (in seconds) multiplied by its depth greater than 0.03 mm second [12,13]. The QRS complex was interpreted utilizing standard criteria [ 141.…”

Section: Methodsmentioning

confidence: 99%

“…In the 24 patients in our study meeting one or more electrocardiographic criteria for left atrial enlargement, 62.5% had a left atrial diameter of 40 mm or more. Termini and Lee [13] also compared various electrocardiographic criteria with echocardiographic evidence of left atrial enlargement and observed agreement to range from 50-77070, depending upon electrocardiographic criteria utilized. Their best agreement, when comparing individual electrocardiographic criteria, was noted using the magnitude of the negative P terminal force in lead Vl.…”

Section: Echocardlographic and Electrocardiographic Correlative Studiesmentioning

confidence: 97%

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Left atrial size and left ventricular function in coronary artery disease: An echocardiographic‐angiographic correlative study

Hamby

Zeldis

Hoffman

et al. 1982

Cathet. Cardiovasc. Diagn.

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M-mode echocardiography was used to determine left atrial size in 100 patients with coronary artery disease undergoing cardiac catheterization. Patients were divided in two groups on the basis of left atrial diameter (greater than or equal to 40 mm in 40 patients and less than 40 mm in 60). Patients with larger left atria had a higher frequency of electrocardiographic evidence of left atrial abnormality (p less than 0.01) and myocardial infarction (p less than 0.001). Pulmonary capillary wedge and left ventricular end-diastolic pressures were higher (p less than 0.005) in patients with larger left atria. An abnormal end-diastolic volume (greater than 100 ml/M2) was observed in 13 patients with enlarged left atria compared to none with normal left atrial size (p less than 0.001). Triple vessel disease was more frequent (63% vs 32%) and single vessel disease less frequent (10% vs 37%) in patients with larger left atria (p less than 0.005). Abnormal left ventricular contractile patterns were noted in 45% of patients with normal left atrial diameters compared to 80% in those with an enlarged left atrium (p less than 0.001). An abnormally low ejection fraction (less than 0.5) was observed in 25% and 80%, respectively, in patients with normal and enlarged left atria (p less than 0.001). Of 58 patients with normal ejection fractions, only 17% had left atrial diameters greater than or equal to 40 mm compared to 71% of 42 patients with abnormally low ejection fractions (p less than 0.001). Of 18 patients with left atrial diameters greater than 42 mm, only two had normal ejection fractions. The mean ejection fraction for patients with left atrial diameters less than 40 mm was 0.63 +/- 0.13 compared to 0.41 +/- 0.18 for those with diameters greater than or equal to 40 mm (p less than 0.001). The sensitivity, specificity, and predictive value for an enlarged left atrium in identifying an abnormal ejection fraction were, respectively, 71, 83, and 75%. These findings indicate that M-mode echocardiographic left atrial enlargement is a useful marker of advanced hemodynamic and angiographic abnormality in patients with coronary artery disease.

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Section: Echocardlographic and Electrocardiographic Correlative Studiessupporting

confidence: 50%

Section: Methodsmentioning

confidence: 99%

Section: Echocardlographic and Electrocardiographic Correlative Studiesmentioning

confidence: 97%

See 1 more Smart Citation

Left atrial size and left ventricular function in coronary artery disease: An echocardiographic‐angiographic correlative study

Hamby

Zeldis

Hoffman

et al. 1982

Cathet. Cardiovasc. Diagn.

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“…P wave area increased in association with prevalence of abnormal P wave morphology as classified using an established binary criterion (algebraic product of negative terminal amplitude and duration ≥40 mm•msec in lead V1). [20]–[22] However, whereas abnormal P wave morphology was associated with LA dilation in univariate analysis (OR 2.05 [CI 1.14–3.71], p = 0.02), forced entry of both P wave area and P wave morphology into a multivariate model demonstrated only P wave area to be positively associated with LA dilation.…”

Section: Resultsmentioning

confidence: 94%

P Wave Area for Quantitative Electrocardiographic Assessment of Left Atrial Remodeling

et al. 2014

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BackgroundLeft atrial (LA) dilation provides a substrate for mitral regurgitation (MR) and atrial arrhythmias. ECG can screen for LA dilation but standard approaches do not assess LA geometry as a continuum, as does non-invasive imaging. This study tested ECG-quantified P wave area as an index of LA geometry.Methods and Results342 patients with CAD underwent ECG and CMR within 7 (0.1±1.4) days. LA area on CMR correlated best with P wave area in ECG lead V1 (r = 0.42, p<0.001), with lesser correlations for P wave amplitude and duration. P wave area increased stepwise in relation to CMR-evidenced MR severity (p<0.001), with similar results for MR on echocardiography (performed in 86% of patients). Pulmonary arterial (PA) pressure on echo was increased by 50% among patients in the highest (45±14 mmHg) vs. the lowest (31±9 mmHg) P wave area quartile of the population. In multivariate regression, CMR and echo-specific models demonstrated P wave area to be independently associated with LA size after controlling for MR, as well as echo-evidenced PA pressure. Clinical follow-up (mean 2.4±1.9 years) demonstrated ECG and CMR to yield similar results for stratification of arrhythmic risk, with a 2.6-fold increase in risk for atrial fibrillation/flutter among patients in the top P wave area quartile of the population (CI 1.1–5.9, p = 0.02), and a 3.2-fold increase among patients in the top LA area quartile (CI 1.4–7.0, p = 0.005).ConclusionsECG-quantified P wave area provides an index of LA remodeling that parallels CMR-evidenced LA chamber geometry, and provides similar predictive value for stratification of atrial arrhythmic risk.

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“…Whilst echo measurements of left atrial size have been shown to correlate well with left atrial volumes determined by angiography (Hirata et al, 1969;Ten Cate et al, 1974), there is little information on how reliable each technique is in detecting left atrial enlargement in the purely clinical situation (Termini and Yu-Chen Lee, 1975;Chirife, Feitosa and Franki, 1975).…”

Section: Introductionmentioning

confidence: 99%

The non-invasive recognition of left atrial enlargement: comparison of electro- and echocardiographic measurements

Ikram

Drysdale

Bones

et al. 1977

Postgraduate Medical Journal

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SummaryThe aim of this study was to compare the ability of electro-and echocardiography to detect enlargement of the left atrium. Seventy-four patients, divided into three groups (eighteen normal, thirty-six valvular disease, twenty hypertension and/or coronary artery disease) were studied. The P wave terminal force in lead V1 (PTF-V1) was measured from a standard 12 lead electrocardiogram, and the internal left atrial dimension (LAD) was measured from time-motion echocardiograms. Linear regression analysis showed a small but significant linear correlation between PTF-V1 and LAD (r = 0-32, P < 0 01). Both methods would separate patients with diseases known to cause left atrial enlargement from normals, but echocardiography showed greater 'specificity ' (100%O v. 94°o) and 'sensitivity' (75%4 v. 67%). It was much superior to the ECG in detecting milder grades of left atrial enlargement and for following serial changes.

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Echocadiographic and Electrocardiographic Criteria for Diagnosing Left Atrial Enlargement

Cited by 19 publications

References 0 publications

Left atrial size and left ventricular function in coronary artery disease: An echocardiographic‐angiographic correlative study

Left atrial size and left ventricular function in coronary artery disease: An echocardiographic‐angiographic correlative study

P Wave Area for Quantitative Electrocardiographic Assessment of Left Atrial Remodeling

The non-invasive recognition of left atrial enlargement: comparison of electro- and echocardiographic measurements

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