Predictive value of P wave terminal force in lead V1 for atrial fibrillation: A meta‐analysis

Huang, Zifang; Zheng, Zhaohui; Wu, Bingyuan; Tang, Leile; Xie, Xiang; Dong, Ruimin; Luo, Yun; Li, Suhua; Zhu, Jun; Liu, Jinlai

doi:10.1111/anec.12739

Cited by 51 publications

(49 citation statements)

References 32 publications

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“…Alternatively, our study may have been underpowered to find any prognostic significance of abnormal PTFV 1 . However, given the lack of survival difference between patients with and without abnormal PTFV 1 , it is unlikely that the abnormal PTFV 1 bears clinically significant meaning with regard to prognosis for patients with severe HF treated with CRT, and from our findings it seems as if abnormal PTFV 1 has limited applicable value in this very sick population in line with previous studies that have shown limitations of abnormal PTFV 1 in different study populations [44, 45]. Our results need to be confirmed in future studies before any conclusions can be made.…”

Section: Discussionsupporting

confidence: 87%

Interatrial Block Predicts Atrial Fibrillation and Total Mortality in Patients with Cardiac Resynchronization Therapy

et al. 2020

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Background: Interatrial block (IAB) and abnormal P-wave terminal force in lead V1 (PTFV1) are electrocardiographic (ECG) abnormalities that have been shown to be associated with new-onset atrial fibrillation (AF) and death. However, their prognostic importance has not been proven in cardiac resynchronization therapy (CRT) recipients. Objective: To assess if IAB and abnormal PTFV1 are associated with new-onset AF or death in CRT recipients. Methods: CRT recipients with sinus rhythm ECG at CRT implantation and no AF history were included (n = 210). Automated analysis of P-wave duration (PWD) and morphology classified patients as having either no IAB (PWD <120 ms), partial IAB (pIAB: PWD ≥120 ms, positive P waves in leads II and aVF), or advanced IAB (aIAB: PWD ≥120 ms and biphasic or negative P wave in leads II or aVF). PTFV1 >0.04 mm•s was considered abnormal. Adjusted Cox regression analyses were performed to assess the impact of IAB and abnormal PTFV1 on the primary endpoint new-onset AF, death, or heart transplant (HTx) and the secondary endpoint death or HTx at 5 years of follow-up. Results: IAB was found in 45% of all patients and independently predicted the primary endpoint with HR 1.9 (95% CI 1.2–2.9, p = 0.004) and the secondary endpoint with HR 2.1 (95% CI 1.2–3.4, p = 0.006). Abnormal PTFV1 was not associated with the endpoints. Conclusions: IAB is associated with new-onset AF and death in CRT recipients and may be helpful in the risk stratification in the context of heart failure management. Abnormal PTFV1 did not demonstrate any prognostic value.

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Section: Discussionsupporting

confidence: 87%

Interatrial Block Predicts Atrial Fibrillation and Total Mortality in Patients with Cardiac Resynchronization Therapy

et al. 2020

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“…Previous studies have identified several P-wave indices that are markers of LA dysfunction and associated with ischaemic stroke with or without AF [17-21, 23-25]. However, these markers of atrial cardiopathy remain most strongly associated with embolic strokes and have not been validated thoroughly in an ESUS cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Given that some of these P-wave indices require further mathematical functions such as multiplication that is required in PTFV1, this can result in the potential magnification of errors [27]. These aforementioned factors could have contributed to some of the heterogeneity in the evidence surrounding the associations of P-wave indices and AF detection as well as stroke in literature [21, 23].…”

Section: Discussionmentioning

confidence: 99%

Association of Electrocardiographic P-Wave Markers and Atrial Fibrillation in Embolic Stroke of Undetermined Source

Yeo

et al. 2020

Cerebrovasc Dis

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Background: Several P-wave indices are thought to represent underlying atrial remodeling and have been associated with ischaemic stroke even in the absence of atrial fibrillation (AF). However, the utility of these P-wave indices in predicting outcomes in patients with embolic stroke of undetermined source (ESUS) has not been studied. The aim of this study is to examine these different P-wave indices towards predicting new-onset AF and stroke recurrence in a cohort of patients with ESUS, thereby demonstrating the value of these electrocardiographic markers for stroke risk stratification. Methods: Between October 2014 and October 2017, consecutive patients diagnosed with ESUS were followed for new-onset AF and ischaemic stroke recurrence. The various P-wave indices, namely, the P-terminal force in the precordial lead V1 (PTFV1), P-wave duration, P-wave dispersion, interatrial blocks, and P-wave axis, were assessed on the initial electrocardiogram on presentation and studied for their relation to eventual AF detection and recurrent stroke. Results: 181 ischaemic stroke patients with ESUS were recruited and followed up for a median duration of 2.1 years. An abnormal PTFV1 was associated with occult AF detection but not with recurrent ischaemic strokes. No significant association was observed between the other P-wave indices with either occult AF or stroke recurrence. Conclusion: PTFV1 is associated with AF detection but not recurrent strokes in ESUS patients and can be a useful electrocardiographic marker for further risk stratification in ESUS patients.

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“…As the left atrial pressure/volume loading rises, the depolarization duration of atrium may be prolonged [ 30 ]. Furthermore, Ren et al [ 11 ] discovered that PTFV1 could predict the diagnosis of tuberculous constrictive pericarditis, while a meta-analysis indicated that PTFV1 is a good predictor of atrial fibrillation occurrence in populations with or without cardiovascular diseases [ 10 ]. In the present study, we found that the incidence of poor outcomes including MACEs was obviously increased in patients with NSTE-ACS who manifested primary PTFV1 (+) at discharge and PTFV1 (+) during hospitalization, based on long-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…P wave terminal force in lead V1 (PTFV1), referred to as the Morris index, is a product of the amplitude (mm) and time (s) of a terminal negative P wave when P waves are positive and negative in both directions, as first proposed by Morris et al [ 9 ] in 1964. Research has shown that abnormal PTFV1 values are related to left ventricular diastolic dysfunction, atrial fibrillation, congestive heart failure, stroke, and death, and they could indicate the severity of cardiac disease [ 10 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

Roles of Morris Index on Poor Outcomes in Patients with Non-ST Segment Elevation Acute Coronary Syndrome

Lin

et al. 2020

Med Sci Monit

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Background This study aimed to assess the roles of the Morris index in predicting poor outcomes in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS). Material/Methods This study included 905 patients with newly diagnosed NSTE-ACS. The Morris index, also known as P wave terminal force in lead V1 (PTFV1), was recorded at admission and discharge. PTVF1 (+) was defined as an absolute value >0.04 mm·s, while PTFV1 (−) was defined as an absolute value <0.04 mm·s. Based on their PTFV1 values at admission/discharge, patients were divided into 4 groups: PTFV1 (−)/(−), PTFV1 (+)/(−), PTFV1 (−)/(+), and PTFV1 (+)/(+). Univariate and multivariate regression analyses were utilized to identify the variables that could contribute to NSTE-ACS risk. Results Compared with the PTFV1 (−)/(−) group, the incidence of poor outcomes was significantly higher in the PTFV1 (−)/(+) (hazard ratio [HR], 3.548; 95% confidence interval [95% CI], 2.024–6.219) and PTFV1 (+)/(+) (HR, 2.133; 95% CI, 1.141–3.986) groups, but not statistically different in the PTFV1 (+)/(−) group (risk ratio, 0.983; 95% CI, 0.424–2.277). Conclusions Primary PTFV1 (+) at discharge and PTFV1 (+) during hospitalization were independent risk factors for poor outcomes, which may provide useful prognostic information for patients with NSTE-ACS.

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Predictive value of P wave terminal force in lead V1 for atrial fibrillation: A meta‐analysis

Cited by 51 publications

References 32 publications

Interatrial Block Predicts Atrial Fibrillation and Total Mortality in Patients with Cardiac Resynchronization Therapy

Interatrial Block Predicts Atrial Fibrillation and Total Mortality in Patients with Cardiac Resynchronization Therapy

Association of Electrocardiographic P-Wave Markers and Atrial Fibrillation in Embolic Stroke of Undetermined Source

Roles of Morris Index on Poor Outcomes in Patients with Non-ST Segment Elevation Acute Coronary Syndrome

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