Inoue Yuko Y, Ipek Esra G, Khurram Irfan M, Ciuffo Luisa, Chrispin Jonathan, Zimmerman Stefan L, Marine Joseph E, Rickard John, Spragg David D, Nazarian Saman, Kusano Kengo, Lima Joao A, Berger Ronald D, Calkins Hugh, Ashikaga Hiroshi
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Am J Cardiol. 2018 Jul 15;122(2):242-247. doi: 10.1016/j.amjcard.2018.03.369. Epub 2018 May 3.
The P-wave terminal force in lead V (PTFV) on the 12-lead electrocardiogram (ECG) quantifies left atrial (LA) structural and electrophysiologic abnormalities. We aimed to evaluate the association between PTFV and cerebrovascular accident (CVA) as well as LA structure and function in patients with atrial fibrillation (AF). We conducted a cross-sectional study of 229 patients with AF (60 ± 10years, 72% men) with (n = 21) and without (n = 208) a history of CVA, who underwent preablation ECG and cardiac magnetic resonance in sinus rhythm. PTFV was defined as the duration (in milliseconds) of the downward deflection of the P wave in lead V multiplied by the absolute value of its amplitude (in microvolts) on ECG. PTFV is associated with LA minimum volume (V) and left ventricular ejection fraction but not associated with the extent of LA fibrosis quantified by cardiac magnetic resonance late gadolinium enhancement. In addition, PTFV is associated with CVA independent of the CHADS-VASc score and LA V (odds ratio 1.23; 95% confidence interval 1.08 to 1.40; p = 0.002). Furthermore, PTFV has an incremental value over the CHADS-VASc score as a marker of CVA (p <0.001). In conclusion, ECG-defined PTFV is independent marker of stroke in patients with AF and reflects the underlying LA remodeling. Our findings suggest that evaluation of PTFV can improve the current risk stratification of stroke.
12导联心电图（ECG）上V导联的P波终末电势（PTFV）可量化左心房（LA）的结构和电生理异常。我们旨在评估PTFV与房颤（AF）患者脑血管意外（CVA）以及LA结构和功能之间的关联。我们对229例AF患者（60±10岁，72%为男性）进行了一项横断面研究，这些患者有（n = 21）或无（n = 208）CVA病史，在窦性心律下接受了消融前心电图和心脏磁共振检查。PTFV定义为V导联心电图上P波向下偏转的持续时间（以毫秒为单位）乘以其振幅绝对值（以微伏为单位）。PTFV与LA最小容积（V）和左心室射血分数相关，但与通过心脏磁共振延迟钆增强定量的LA纤维化程度无关。此外，PTFV与CVA相关，独立于CHADS-VASc评分和LA V（优势比1.23；95%置信区间1.08至1.40；p = 0.002）。此外，作为CVA的标志物，PTFV相对于CHADS-VASc评分具有增量价值（p <0.001）。总之，心电图定义的PTFV是AF患者中风的独立标志物，反映了潜在的LA重塑。我们的研究结果表明，评估PTFV可以改善当前的中风风险分层。
