%0 Journal Article
%T P Wave Area for Quantitative Electrocardiographic Assessment of Left Atrial Remodeling
%A Jonathan W. Weinsaft
%A Jonathan D. Kochav
%A Jiwon Kim
%A Sergey Gurevich
%A Samuel C. Volo
%A Anika Afroz
%A Maya Petashnick
%A Agnes Kim
%A Richard B. Devereux
%A Peter M. Okin
%J PLOS ONE
%D 2014
%I Public Library of Science (PLoS)
%R 10.1371/journal.pone.0099178
%X 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¡À1.4) 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¡À14 mmHg) vs. the lowest (31¡À9 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¡À1.9 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¨C5.9, p = 0.02), and a 3.2-fold increase among patients in the top LA area quartile (CI 1.4¨C7.0, 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.
%U http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0099178