P wave area for quantitative electrocardiographic assessment of left atrial remodeling

Jonathan W. Weinsaft, Jonathan D. Kochav, Jiwon Kim, Sergey Gurevich, Samuel C. Volo, Anika Afroz, Maya Petashnick, Agnes Kim, Richard B. Devereux, Peter M. Okin

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26 Scopus citations


Background: Left 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 Results: 342 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). Conclusions: ECG-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.

Original languageEnglish (US)
Article numbere99178
JournalPloS one
Issue number6
StatePublished - Jun 5 2014


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