The prognostic value of the P wave morphology in the discharge ECG in a 5-year follow-up study after myocardial infarction

Pohjola, Sirpa; Siltanen, P; Romo, Matti

doi:10.1016/0002-8703(79)90317-x

Cited by 13 publications

(5 citation statements)

References 37 publications

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“…17 In a registry-based analysis of discharge ECGs of 641 patients who survived the acute phase of myocardial infarction, abnormal PTF (PTF > 0.03 mVs), observed in 11% of the patients, was associated with a nearly two-fold increase in 5-year mortality. 4 In another, smaller study, abnormal PTF was found to be the main predictor of poor prognosis at 4-year follow-up. 3 To the best of our knowledge, no other studies have evaluated the impact of P-wave morphology on mortality in any other patient population since.…”

Section: Ecg-based Risk Stratification In Patients With Ischemic Hearmentioning

confidence: 91%

“…Abnormal PTF was initially interpreted as a sign of left atrial overload. 3,4,17 Subsequent studies using echocardiography reported moderate specificity and poor sensitivity of abnormal PTF for detecting left atrial enlargement. [18][19][20] In a recent report using cardiovascular magnetic resonance, abnormal PTF was shown to be a highly specific but insensitive ECG sign of left atrial enlargement.…”

Section: Substrate Of Variable P-wave Morphology: Structural Electrimentioning

confidence: 99%

“…Two reports published in the 1970s demonstrated the prognostic value of abnormal left atrial activation with respect to longterm follow-up, in patients surviving acute myocardial infarction. 3,4 A noninvasive ECG analysis tool that allows detailed description of P-wave morphology has been developed that includes signal averaging of P waves and automatic classification of P-wave morphology (PSA-ECG). 5 Using this technique, we have identified P-wave morphologies associated with a history of AF 6 as well as age-related P-wave changes in healthy individuals.…”

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confidence: 99%

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Abnormal P‐Wave Morphology Is a Predictor of Atrial Fibrillation Development and Cardiac Death in MADIT II Patients

Holmqvist¹,

Platonov²,

McNitt³

et al. 2010

Noninvasive Electrocardiol

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Section: Ecg-based Risk Stratification In Patients With Ischemic Hearmentioning

confidence: 91%

Section: Substrate Of Variable P-wave Morphology: Structural Electrimentioning

confidence: 99%

mentioning

confidence: 99%

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Abnormal P‐Wave Morphology Is a Predictor of Atrial Fibrillation Development and Cardiac Death in MADIT II Patients

Holmqvist¹,

Platonov²,

McNitt³

et al. 2010

Noninvasive Electrocardiol

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“…46 These pathophysiological associations may likely explain the difference in long-term outcome associated with abnormal PTF in patients discharged after STelevation myocardial infarction. 47,48 In the MADIT-II cohort, atypical P-wave morphology (i.e., P waves that did not belong to any of the two most common morphology classes (Type 1 or Type 2, see Fig. 3)) was independently associated with heart failure-related death in a multivariate analysis.…”

Section: P-wave Morphology As Predictor Of Clinical Outcomementioning

confidence: 97%

P‐Wave Morphology: Underlying Mechanisms and Clinical Implications

Platonov¹

2012

Noninvasive Electrocardiol

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Increasing awareness of atrial fibrillation (AF) and its impact on public health revives interest in identification of noninvasive markers of predisposition to AF and ECG-based risk stratification. P-wave duration is generally accepted as the most reliable noninvasive marker of atrial conduction, and its prolongation has been associated with history of AF. However, patients with paroxysmal AF without structural heart disease may not have any impressive P-wave prolongation, thus suggesting that global conduction slowing is not an obligatory requirement for development of AF. P-wave morphology is therefore drawing increasing attention as it reflects the three-dimensional course of atrial depolarization propagation and detects local conduction disturbances. The factors that determine P-wave appearance include (1) the origin of the sinus rhythm that defines right atrial depolarization vector, (2) localization of left atrial breakthrough that defines left atrial depolarization vector, and (3) the shape and size of atrial chambers. However, it is often difficult to distinguish whether P-wave abnormalities are caused by atrial enlargement or interatrial conduction delay. Recent advances in endocardial mapping technologies have linked certain P-wave morphologies with interatrial conduction patterns and the function of major interatrial conduction routes. The value of P-wave morphology extends beyond cardiac arrhythmias associated with atrial conduction delay and can be used for prediction of clinical outcome of a wide range of cardiovascular disorders, including ischemic heart disease and congestive heart failure.

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“…The prognosis after acute myocardial in farction (AMI) depends primarily upon left ventricular function [1], This statement seems to apply also to right ventricular in farction [2], Several additional prognostic factors have also been recognized [3][4][5][6][7][8][9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Right Ventricular Aneurysm: A New Prognostic Indicator after a First Acute Myocardial Infarction

et al. 1991

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The prognostic implication of a right ventricular aneurysm after a first acute myocardial infarction (AMI) was assessed on a series of 137 AMI patients 12 of whom had a right ventricular aneurysm detected at radionuclide angiocardiography. The follow-up lasted 36 months. Mortality was 50 and 18.4% in patients with and without right ventricular aneurysm, respectively (p < 0.02). Groups did not differ in age, male-to-female ratio, AMI site, left ventricular ejection fraction (LVEF), peak filling rate (PFR), left ventricular size. A multivariate logistic analysis showed that only three out of ten clinical and functional variables qualified to be independent predictors of death: right ventriuclar aneurysm (odd ratio = 2.48, confidence limits = 1.21–4.98), LVEF < 52% (odd ratio = 1.91, confidence limits = 1.03–3.48), abnormal terminal P wave forces (odd ratio = 1.72, confidence limits = 1.07–2.75). The analysis of single case histories did not provide a clue to clarify the reasons accounting for the negative prognostic implication of a right ventricular aneurysm. In conclusion, a significant positive relationship between right ventricular aneurysm and mortality after AMI has been demonstrated; further study is needed to clarify the relevant mechanisms.

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The prognostic value of the P wave morphology in the discharge ECG in a 5-year follow-up study after myocardial infarction

Cited by 13 publications

References 37 publications

Abnormal P‐Wave Morphology Is a Predictor of Atrial Fibrillation Development and Cardiac Death in MADIT II Patients

Abnormal P‐Wave Morphology Is a Predictor of Atrial Fibrillation Development and Cardiac Death in MADIT II Patients

P‐Wave Morphology: Underlying Mechanisms and Clinical Implications

Right Ventricular Aneurysm: A New Prognostic Indicator after a First Acute Myocardial Infarction

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