Abstract 15306: Detection of Left Ventricular Diastolic Dysfunction Using P Wave Morphology on Electrocardiography
Background: Left ventricular (LV) diastolic dysfunction could determine exercise capacity and is relevant to prognosis of patients with heart failure.
Assessment of its presence is critical for the diagnosis and management of heart failure, but it requires imaging modality such as echocardiography. Left atrial (LA) enlargement is associated with LV diastolic dysfunction, and P-wave morphology on electrocardiography (ECG) has been used for the diagnosis of LA enlargement. We investigated whether P-wave morphology could predict LV diastolic dysfunction.
Methods and Results: We analyzed ECG in 543 patients who showed biphasic P wave in V1 lead among consecutive 775 patients who underwent ECG and echocardiography in a same day. Patients with history of apparent atrial fibrillation were excluded. We measured P-wave duration and P terminal force in V1 lead using a digital caliper. We measured early mitral valve flow velocity (E) and septal mitral valve annular velocity (e’) on echocardiography to determine an E/e’ ratio, and also measured LA volume to determine LA volume index (LAVI). LV diastolic dysfunction was defined as E/e’ ratio >15 and LAVI ≥ 34 mL/m2 based on criteria endorsed by American Society of Echocardiography.
LV diastolic dysfunction was diagnosed in 28 patients (5.2%). The patients with diastolic dysfunction had larger P terminal force (0.060±0.037 mVsec vs. 0.044±0.027, p=0.003) and wider P wave duration (107.2±23.5 vs. 96.9±19.8 msec, p=0.008) than those without diastolic dysfunction. Receiver operator curve (ROC) analysis demonstrated that P terminal force predicted LV diastolic dysfunction with sensitivity of 75.0% and specificity of 56.9% when 0.040 mVsec was used as an optimal cutoff value (AUC=0.65). P wave duration detected diastolic dysfunction with sensitivity of 46.4% but with specificity of 83.0%, using 112 msec as a cutoff value (AUC=0.65).
Conclusions: P terminal force in V1 lead detected LV diastolic dysfunction with a good sensitivity while P wave duration detected it with high specificity but with low sensitivity. P wave morphology of V1 lead could be used as a screening tool for LV diastolic dysfunction in daily practice.
- © 2013 by American Heart Association, Inc.