P-Wave Analysis in Valvular Heart Disease

Abstract

Electrocardiographic analysis of the P waves occurring in a series of 113 normal subjects and 100 patients with specifically defined valvular lesions are reviewed. The former methods of analysis showed a marked lack of specificity. By dividing the P wave in lead V 1 into initial and terminal portions, a measure designated as the P terminal force has been derived. This measure is of value in two respects: (1) it correctly separates normal subjects from those patients with left-sided valvular lesions in 92 per cent of this series and (2) once a given valve lesion is suspected clinically, this measure enables one to make an estimation of the severity of that lesion from the degree of abnormality of the P terminal force at V 1 . The P terminal force does not indicate the type of valvular disease present, nor does it correlate with any one specific hemodynamic measure. The abnormality does appear to be related, within each separate type of valve disease, to the specific hemodynamic abnormality of that type of valvular involvement. The anatomic and electrophysiologic changes that might relate to these P-wave changes are discussed.

The non-invasive recognition of left atrial enlargement: comparison of electro- and echocardiographic measurements

“…Several comparisons have been reported of the various electrocardiogram criteria suggested for LA enlargement (Morris et al, 1964;Arevalo et al, 1963;Gooch et al, 1966;Saunders et al, 1967) and all indicate PTF-V1 to be the most sensitive. The present results indicated clearly that neither the duration nor the depth of the terminal portion of the P wave was as sensitive an index as a combination of both.…”

“…They include the classical 'P mitrale' (Lewis, 1920;Berliner and Master, 1938), the ratio of the duration of the P wave to the PR segment also called the Macruz Index (Macruz, Perloff and Case, 1958) and the product of the P terminal force duration (in sec) and its depth (in mm) in lead V1. The latter is generally regarded as the best electrocardiographic criterion for detecting left atrial enlargement (Morris et al, 1964;Hurst et al, 1963;Soloff and Zatuchini, 1958).…”

Electrocardiographic changes in 1000 highly trained junior elite athletes.

“…10 Left atrial enlargement was defined as a biphasic P wave in V1 where the terminal portion was more negative than −0.1 mV and 0.04 seconds or more in duration. 10 Left and right ventricular hypertrophy (LVH and RVH) were defined by the Sokolow-Lyon voltage criterion. 11 12 LVH was defined by the sum of the S waves in V1 and the R waves in V5 exceeding 3.5 mV.…”

An echocardiographic assessment of cardiac morphology and common ECG findings in teenage professional soccer players: reference ranges for use in screening

“…The QT intervals were corrected for heart rate (QTc) using Bazett's formula 14. P wave voltage was assessed in lead V1, and right atrial enlargement was defined as a P wave voltage of 0.25 mV or above 15. Left ventricular hypertrophy was defined by the Solokow–Lyon voltage criteria16 and the Romhilt–Estes points score system, a score of 5 or more indicating left ventricular hypertrophy 17.…”