Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
PLoS One. 2012;7(8):e42815. doi: 10.1371/journal.pone.0042815. Epub 2012 Aug 27.
The P wave parameters measured by 12-lead electrocardiogram (ECG) are commonly used as noninvasive tools to assess for left atrial enlargement. There are limited studies to evaluate whether P wave parameters are independently associated with decline in renal function. Accordingly, the aim of this study is to assess whether P wave parameters are independently associated with progression to renal end point of ≥25% decline in estimated glomerular filtration rate (eGFR). This longitudinal study included 166 patients. The renal end point was defined as ≥25% decline in eGFR. We measured two ECG P wave parameters corrected by heart rate, i.e. corrected P wave dispersion (PWdisperC) and corrected P wave maximum duration (PWdurMaxC). Heart function and structure were measured from echocardiography. Clinical data, P wave parameters, and echocardiographic measurements were compared and analyzed. Forty-three patients (25.9%) reached renal end point. Kaplan-Meier curves for renal end point-free survival showed PWdisperC > median (63.0 ms) (log-rank P = 0.004) and PWdurMaxC > median (117.9 ms) (log-rank P<0.001) were associated with progression to renal end point. Multivariate forward Cox-regression analysis identified increased PWdisperC (hazard ratio [HR], 1.024; P = 0.001) and PWdurMaxC (HR, 1.029; P = 0.001) were independently associated with progression to renal end point. Our results demonstrate that increased PWdisperC and PWdurMaxC were independently associated with progression to renal end point. Screening patients by means of PWdisperC and PWdurMaxC on 12 lead ECG may help identify a high risk group of rapid renal function decline.
心电图（ECG）12 导联测量的 P 波参数通常被用作评估左心房扩大的非侵入性工具。目前有限的研究评估了 P 波参数是否与肾功能下降独立相关。因此，本研究旨在评估 P 波参数是否与估算肾小球滤过率（eGFR）下降≥25%的肾脏终点进展独立相关。这项纵向研究纳入了 166 名患者。肾脏终点定义为 eGFR 下降≥25%。我们测量了两个经心率校正的心电图 P 波参数，即校正的 P 波离散度（PWdisperC）和校正的 P 波最大持续时间（PWdurMaxC）。心脏功能和结构通过超声心动图进行测量。比较和分析了临床数据、P 波参数和超声心动图测量结果。43 名患者（25.9%）达到肾脏终点。肾脏终点无事件生存的 Kaplan-Meier 曲线显示 PWdisperC＞中位数（63.0ms）（对数秩检验 P=0.004）和 PWdurMaxC＞中位数（117.9ms）（对数秩检验 P<0.001）与肾脏终点进展相关。多变量向前 Cox 回归分析确定 PWdisperC 增加（风险比 [HR]，1.024；P=0.001）和 PWdurMaxC 增加（HR，1.029；P=0.001）与肾脏终点进展独立相关。我们的研究结果表明，PWdisperC 和 PWdurMaxC 的增加与肾脏终点进展独立相关。通过 12 导联 ECG 对 PWdisperC 和 PWdurMaxC 进行筛查可能有助于识别肾功能快速下降的高危人群。
