Evaluation of atrial electromechanical functions in dipper and nondipper hypertension patients using left atrial strain P‐wave dispersion and P terminal force

Tosun, Veysel; Korucuk, Necmettin; Kılınç, Ali Yaşar; Uygun, Turgut; Altekin, Refik Emre; Güntekin, Ünal; Ermis, Cengiz

doi:10.1111/echo.14041

Cited by 12 publications

(12 citation statements)

References 30 publications

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“…Previous research has found moderate to strong relationships between atrial conduction and PWD 12,13,15–19 . However, in our study they were weak as observed in the correlation coefficients obtained.…”

Section: Discussioncontrasting

confidence: 78%

Atrial conduction explains the occurrence of the P‐wave dispersion phenomenon, but weakly

Puerta¹,

Chávez-González²,

López-Calleja³

et al. 2020

Journal of Arrhythmia

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Background P‐wave dispersion (PWD) is believed to be caused by inhomogeneous atrial conduction. This statement, however, is based on limited little solid evidence. The aim of this study was to determine the relationship between atrial conduction and PWD by means of invasive electrophysiological studies. Methods Cross‐sectional study in 153 patients with accessory pathways and atrioventricular node reentry tachycardia (AVNRT) undergoing an electrophysiological study. Different atrial conduction times were measured and correlated with PWD. Results Only the interatrial (P‐DCS) and left intra‐atrial conduction times (ΔDCS‐PCS) showed a significant correlation with PWD, but this correlation was weak. Multivariate linear regression analysis determined that both P‐DCS (β = 0.242; P = .008) and ΔDCS‐PCS (β = 0.295; P < .001) are independent predictors of PWD. Performing the multivariate analysis for arrhythmic substrates, it is observed that only ΔDCS‐PCS continued to be an independent predictor of PWD. Analysis of the receiver operating characteristic curves showed that regardless of the types of arrhythmic substrates, PWD discriminates significantly, but moderately, to patients with P‐DCS and ΔDCS‐PCS ≥75 percentile. Conclusions Interatrial and intraleft atrial conduction times were directly and significantly correlated with PWD, but only weakly, and were independent predictors of PWD. In general, PWD correctly discriminates patients with high values in interatrial and intraleft atrial conduction times, but moderately. This is maintained in cases with accessory pathways; however, in patients with AVNRT it only does so for intraleft atrial conduction times. Interatrial and intraleft atrial conduction times weakly explains PWD.

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Section: Discussioncontrasting

confidence: 78%

Atrial conduction explains the occurrence of the P‐wave dispersion phenomenon, but weakly

Puerta¹,

Chávez-González²,

López-Calleja³

et al. 2020

Journal of Arrhythmia

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“…To achieve greater precision in measuring P‐wave dispersion, we measured simultaneous digital recording of all 12 ECG leads and on computer screen with the high zoom capabilities, Figure 1. P‐wave dispersion is defined as the difference between maximum and minimum P‐wave durations measured at all ECG derived leads (Acar et al., 2009; Badran et al., 2019; Liu et al., 1998; Magnani et al., 2010; Pala et al., 2010; Rein et al., 2003; Sanders et al., 2003; Tosun et al., 2018). Intraobserver and interobserver coefficients of variation were found to be 4.1% and 4.4% for PWD, respectively (Badran et al., 2019; Pala et al., 2010; Tosun et al., 2018…”

Section: Methodsmentioning

confidence: 99%

Relation of atrial electromechanical delay to P‐wave dispersion on surface ECG using vector velocity imaging in patients with hypertrophic cardiomyopathy

Badran

Soltan

Eltahan

et al. 2020

Noninvasive Electrocardiol

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Objectives Heterogeneity of structural and electrophysiologic properties of atrial myocardium is common characteristic in hypertrophic cardiomyopathy (HCM). We assessed the dispersion of atrial refractoriness on surface ECG using P‐wave dispersion (PWD) and its relation to atrial electromechanical functions using vector velocity imaging (VVI) in HCM population. Methods Seventy‐nine HCM patients (mean age: 43.7 ± 13 years, 67% male) were compared with 25 healthy individuals as control. P‐wave durations, Pmax and Pmin, P‐wave dispersion (PWD), and P terminal force (PTF) were measured from 12‐lead ECG. LA segmental delay (TTP‐d) and dispersion (TTP‐SD) of electromechanical activation were derived from atrial strain rate curves. Results HCM patients had longer PR interval, PW duration, higher PWD, PTF, QTc compared to control (p < .001). HCM patients were classified according to presence of PWD into two groups, group I with PWD > 46 ms (n = 25) and group II PWD ≤ 46 ms (n = 54). Group I showed higher prevalence of female gender, higher PTF, QTc interval, left ventricular outflow tract (LVOT) obstruction, p < .01, LVOT gradient (p < .001), LV mass index (p < .01), E/E' (p < .01), and severe mitral regurgitation (p < .001). Moreover, PWD was associated with increased atrial electromechanical delay (TTP‐d) and LA mechanical dyssynchrony (TTP‐SD), p < .001. LA segmental delay and dispersion of electromechanical activation were distinctly higher among HCM patient. Conclusion PWD is simple ECG criterion, and it is associated with more severe HCM phenotype and LA electromechanical delay while PTF is linked only to atrial remodeling.

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“…In five of the 10 articles, the P wave maximum was significantly higher with elevated BP. The five articles with the differences between HT participants and NT participants noted differences ranging from 2.8 to 23.3 ms (44,(58)(59)(60)(61). The nonsignificant articles had populations that had younger average ages (22.7 to 51.6 vs. 44.7 to 53.6 years old), healthier with none or less comorbidities listed, and all of them were recently diagnosed with hypertension or did not have hypertensive participants (13,42,56,62,63).…”

Section: Comparing Ecg Wave Morphologymentioning

confidence: 99%

“…Two or fewer articles looked at other QT features, such as QT maximum, QT minimum, and abnormal QT dispersion. The most articles analyzed QTc duration, and five of nine articles found it was significantly P wave duration Average P wave duration in each all lead (in milliseconds) (42) P wave prolongation P wave longer than 120 ms (43) P wave dispersion Difference between P wave maximum and P wave minimum (in milliseconds) (13) P wave area Total area under and above the isoelectric line from the beginning to the end of the P wave (13) OR The product of P-wave amplitude per half of lead II duration (42) P wave amplitude Amplitude of P wave (in millivolts) (42) P wave terminal force "Product of the duration (in seconds) and amplitude (in millimeters) of the negative terminal deflection of the P-wave" (44) PR interval Length between the beginning of the P wave to the beginning of the QRS complex (13) QT maximum, minimum, dispersion and duration Similar to P wave above.…”

Section: Comparing Ecg Wave Morphologymentioning

confidence: 99%

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

et al. 2020

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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.

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Evaluation of atrial electromechanical functions in dipper and nondipper hypertension patients using left atrial strain P‐wave dispersion and P terminal force

Abstract: Nondipping pattern in hypertensive patients had a worse cardiac remodeling, and impaired mechanical LA function compared with dipping pattern. The PWD and PTF findings support these changes.

Cited by 12 publications

References 30 publications

Atrial conduction explains the occurrence of the P‐wave dispersion phenomenon, but weakly

Atrial conduction explains the occurrence of the P‐wave dispersion phenomenon, but weakly

Relation of atrial electromechanical delay to P‐wave dispersion on surface ECG using vector velocity imaging in patients with hypertrophic cardiomyopathy

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

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