P-wave analysis in myocardial infarction, pulmonary edema, and embolism

Abraham, Abraham S.

doi:10.1016/0002-8703(75)90079-4

Cited by 10 publications

(1 citation statement)

References 13 publications

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“…Various investigators have also demonstrated reversible changes in P terminal force during acute left ventricular failure and in the course of acute myocardial infarction. '3 14 These observations represent a controversy as to whether an abnormal P wave indicates dilatation of the left atrium or pressure overload.…”

Section: Discussionmentioning

confidence: 99%

Left atrial enlargement. Echocardiographic assessment of electrocardiographic criteria.

Waggoner¹,

Adyanthaya²,

Quiñones³

et al. 1976

Circulation

113

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SUMMARY A comparison of electrocardiographic manifestations of left atrial enlargement (LAE) and left atrial size by echocardiography was made in 307 patients in sinus rhythm. Electrocardiographic criteria used were L: P wave duration in lead II equal to or greater than 0.12 sec; Va: the ratio of the duration of negative terminal P in V, to the P-R segment equal to or greater than 1.0; Vb: a negative P terminal force in V, less than -0.03 mm sec. The echocardiographic diagnosis of left atrial enlargement was based on 1) transverse dimension greater than 4.0 cm, or 2) a ratio of transverse MANY ELECTROCARDIOGRAPHIC CRITERIA have been proposed for detecting enlargement of the left atrium.'-' Although much attention has been directed to changes in P wave morphology in left atrial enlargement, there has been no reliable noninvasive "standard" with which these abnormalities may be compared. The advent of echocardiography has provided such a standard. Previous investigators have found good correlation between echocardiographic left atrial dimension and left atrial angiographic area.6 7 Brown and associates found the ratio of left atrium to aortic root dimension improved sensitivity of the echocardiogram over measurements used previously.8 The reliability of the electrocardiogram in detecting left atrial enlargement was evaluated in our patient population using echocardiography as a standard for comparison. Two recognized electrocardiographic criteria for left atrial enlargement and a third frequently used at this institution were evaluated. Materials and MethodsEchocardiograms and 12-lead electrocardiograms were obtained on 427 patients studied at the Ben Taub General Hospital between June 30, 1973 and June 30, 1974. Four patients in whom satisfactory echocardiographic measurements could not be obtained were excluded. Eighty-four additional patients were excluded, as the electrocardiograms and echocardiograms were done two or more months apart. The age range in this remaining group of 339 patients (200 atrial to transverse aortic root dimension greater than 1.17. In the presence of left atrial enlargement, a combination of criteria occurred more often than a single criterion. The overall predictive index of the electrocardiogram for left atrial enlargement was 63% (excluding criterion Vb raised probability to 80%); and that for absence of left atrial enlargement was 78%. The index of coarse versus fine fibrillary waves was unreliable in predicting left atrial enlargement. Changes in P wave morphology may be used as a reasonably specific but less sensitive indicator of left atrial enlargement.been discussed previously.' Briefly, the transducer was placed in the fourth interspace along the left sternal border and directed posteriorly, cephalad, and medially to record the aorta and left atrium. Measurements at this point were carefully obtained from the aortic root at end diastole and left atrium at end systole, as shown in figure 1. Adjustments in gain were sometimes necessary to clarify left atrial wall motion or the...

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Section: Discussionmentioning

confidence: 99%