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

Ikram, H.; Drysdale, P.; Bones, Philip J.; Chan, WM

doi:10.1136/pgmj.53.621.356

Cited by 11 publications

(6 citation statements)

References 19 publications

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“…In addition, the high specificity of the criteria of P wave axis < 30° to detect LAE has not been previously described to our knowledge. Compared with prior M-mode echocardiographic studies [ 16 , 18 , 23 , 25 ], we found higher sensitivity but lower specificity for P > 0.11s, and similar excellent specificity for P mitrale and NPTF-V1 > 0.04s·mm to detect CMR LAE. The overall increased sensitivity of ECG LAE compared to ECG RAE may be explained by a larger number of criteria used, as well as high prevalence of the very sensitive criteria P > 0.11s.…”

Section: Discussionsupporting

confidence: 49%

“…An ECG in sinus rhythm, no more than 35 days from the CMR scan and prior to any pulmonary vein ablation procedures, was obtained for subjects with AF (n = 74). ECG LAE was defined by any one of the following: 1) P wave in any lead > 0.11s, 2) Notched P wave with interpeak duration > 0.04s (P mitrale), 3) P wave axis < 30°, 4) Area of negative P terminal force in lead V1 (NPTF-V1) > 0.04s·mm, or 5) Positive P terminal force in aVL (PPTF-aVL) > 0.5 mm [ 16 , 18 , 23 , 25 ]. ECG RAE included 1) P wave in inferior leads II, III, aVF > 2.5 mm or 2) Positive P wave in V1 > 1.5 mm [ 26 , 27 ].…”

Section: Methodsmentioning

confidence: 99%

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Accuracy of electrocardiographic criteria for atrial enlargement: validation with cardiovascular magnetic resonance

Tsao

Josephson

Hauser

et al. 2008

Journal of Cardiovascular Magnetic Resonance

104

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Background: Anatomic atrial enlargement is associated with significant morbidity and mortality. However, atrial enlargement may not correlate with clinical measures such as electrocardiographic (ECG) criteria. Past studies correlating ECG criteria with anatomic measures mainly used inferior M-mode or two-dimensional echocardiographic data. We sought to determine the accuracy of the ECG to predict anatomic atrial enlargement as determined by volumetric cardiovascular magnetic resonance (CMR).

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Section: Discussionsupporting

confidence: 49%

Section: Methodsmentioning

confidence: 99%

Accuracy of electrocardiographic criteria for atrial enlargement: validation with cardiovascular magnetic resonance

Tsao

Josephson

Hauser

et al. 2008

Journal of Cardiovascular Magnetic Resonance

104

View full text Add to dashboard Cite

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“…In fact, although there is an increased specificity of P wave duration from 20 up to 50 milliseconds, the possibility to discriminate the presence of LAE detected by echocardiography was poor. Similarly, in humans, individual ECG P wave changes (P wave duration, axis and morphology) do not reliably detect nor predict the presence of anatomic atrial enlargement, when compared with cardiac magnetic resonance imaging (Tsao and others 2008) or echocardiography (Ikram and others 1977; Lee and others 2007).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of P wave duration in the identification of left atrial enlargement in dogs

Savarino

Borgarelli

Tarducci

et al. 2012

J of Small Animal Practice

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OBJECTIVES: To determine sensitivity and specificity of P wave duration in the identification of left atrial enlargement in dogs.METHODS: Electrocardiograms from normal dogs and dogs with various cardiovascular diseases were evaluated. Inclusion criteria were the availability of an electrocardiogram showing a stable isoelectric line, easily recognizable P waves and good quality two-dimensional echocardiographic estimate of left atrial dimensions using the left atrial to aortic root ratio.Using a metal caliper system, P wave duration was measured to the nearest 10 milliseconds for six consecutive heart beats; data were then averaged for each dog. The accuracy of P wave duration in predicting left atrial enlargement was determined using a receiver operating characteristic analysis. RESULTS: One hundred and fifty-six dogs were included in the study. Average P wave durations of 20, 30, 40 and 50 milliseconds yielded sensitivities of 100, 85, 68 and 40% and specificities of 0, 16, 64 and 93%, respectively, for the diagnosis of Left Atrial Enlargement by echocardiography. The estimated area under curve of the receiver operating characteristic curve was 0·70 (95% confidence interval: 0·60 to 0·80).CLINICAL SIGNIFICANCE: The diagnostic performance of P wave duration for identification of left atrial enlargement in dogs presents considerable limitations.

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“…Most of them reported relatively low sensitivity but much higher specificity of these criteria, often approximating 100% [10,12] .…”

Section: Discussionmentioning

confidence: 99%

“…In the past, several studies have assessed the accuracy of ECG criteria in prediction of LA enlargement using echocardiography and often demonstrated conflicting results [10][11][12][13] . Most of them reported relatively low sensitivity but much higher specificity of these criteria, often approximating 100% [10,12] .…”

Section: Discussionmentioning

confidence: 99%

Sensitivity and specificity of ECG criteria of left atrial enlargement in comparison to cardiac magnetic resonance in patients with hypertrophic cardiomyopathy

Kłopotowski¹,

Jasińska²,

Jarmus³

et al. 2016

Heart Beat

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Background. In patients with hypertrophic cardiomyopathy (HCM), left atrial (LA) enlargement has been related to increased risk of sudden cardiac death. Cardiac magnetic resonance (CMR) is the method of choice in the assessment of LA size and volume. However, initial assessment of LA enlargement is often made by means of ECG criteria including P wave analysis in leads II and V1. The aim of the study was to assess the sensitivity and specificity of ECG criteria for LA enlargement in relation to CMR. Materials and methods:The study included 236 patients (62.7% male, median age 47 years) with documented HCM and sinus rhythm on 12-lead ECG who underwent CMR study. ECGs were digitally analyzed for the following criteria: P wave duration in lead II >120 ms or area of negative P-terminal force in V1 ≥ 40 ms.mm. LA volume index (LAVI) > 53 ml/m 2 was used as a cut-off value of LA enlargement in CMR studies.Results: LA enlargement on ECG was found in 109 patients (46.2%) and on CMR in 48 patients (20.3%). Sensitivity, specificity, and positive and negative predictive values of LA enlargement based on P wave characteristics in lead II were 54.1%, 67.4%, 36.7% and 80.8% and in lead V1 32.8%, 80.0%, 36.4% and 77.3%. Conclusions:Current ECG criteria of LA enlargement have limited diagnostic value in detection of LA enlargement due to their low sensitivity and only moderate specificity.

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

Cited by 11 publications

References 19 publications

Accuracy of electrocardiographic criteria for atrial enlargement: validation with cardiovascular magnetic resonance

Accuracy of electrocardiographic criteria for atrial enlargement: validation with cardiovascular magnetic resonance

Diagnostic performance of P wave duration in the identification of left atrial enlargement in dogs

Sensitivity and specificity of ECG criteria of left atrial enlargement in comparison to cardiac magnetic resonance in patients with hypertrophic cardiomyopathy

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