Sawonik Sebastian, Wysokiński Andrzej P, Zapolski Tomasz
Department of Cardiology, Independent Public Teaching Hospital No. 4 in Lublin, Lublin, Poland.
Department of Cardiology, Medical University of Lublin, Lublin, Poland.
Med Sci Monit. 2025 Aug 12;31:e947360. doi: 10.12659/MSM.947360.
BACKGROUND Left atrial (LA) remodeling (LAR) is a risk factor for atrial fibrillation (AF) and ischemic stroke (IS). LAR can be detected on electrocardiogram (ECG) by P wave indices. The aim of this study was to search for noninvasively assessed LAR markers associated with the history of IS in patients with AF, considering differences between males and females. MATERIAL AND METHODS This retrospective study included a group of 256 patients, aged 76.19 (±9.64) years, with documented AF and after IS. The control group consisted of 70 people aged 68.43 (±7.38) years with AF but without IS. The collected study material included ECG (longest P wave duration [Pmax], P wave duration [PWD], P wave dispersion [PWDI], P wave terminal force in lead V₁ [PWTFV₁], negative phase duration of the P in V₁ [PWDNV1]) and trans-thoracic echocardiography. Results were compared among both sexes and the control group. RESULTS In the study group, electrophysiological LAR was more advanced than in the control group, with significantly higher PWDI (80.60(±23.05) vs 62.49(±14.92) ms; p<0.001) and lower percentage of patients with normal Pmax/PWTFV1/PWDNV1/PWDI indices (2.73 vs 11.43%; p<0.05) respectively. LA area was larger (28.33(±7.50) vs 21.26(±2.79) cm²; p<0.001) and LVEF was lower (54.85(±9.14) vs 58.17(±6.40); p<0.05) in the study group compared to the control group. PWTF (4801.6(±3695.4) vs 4127.8(±3689.6) mcV*ms; p=0.049) was higher in males than in females. In multivariable logistic regression analysis, predictors significantly associated with IS occurrence in patients with AF were: higher PWDV₁ values (95% CI: 1.02-1.08, p<0.001), Pmax (95% CI: 0.90-0.97, p<0.001), and LVEF (95% CI: 0.84-0.99, p=0.030). CONCLUSIONS In patients with IS, higher indices of both structural and electrophysiological LAR are observed. There are significant differences between the sexes in the severity of LAR indices.
左心房重塑（LAR）是心房颤动（AF）和缺血性卒中（IS）的危险因素。LAR可通过心电图（ECG）上的P波指标检测到。本研究的目的是寻找与AF患者IS病史相关的非侵入性评估LAR标志物，并考虑男女之间的差异。
这项回顾性研究纳入了一组256例年龄为76.19（±9.64）岁、有AF记录且曾患IS的患者。对照组由70例年龄为68.43（±7.38）岁、有AF但无IS的患者组成。收集的研究资料包括ECG（最长P波时限[Pmax]、P波时限[PWD]、P波离散度[PWDI]、V₁导联P波终末电势[PWTFV₁]、V₁导联P波负向时限[PWDNV1]）和经胸超声心动图。对两组性别及对照组的结果进行比较。
研究组的电生理LAR比对照组更严重，PWDI显著更高（80.60（±23.05）vs 62.49（±14.92）ms；p<0.001），而Pmax/PWTFV1/PWDNV1/PWDI指标正常的患者百分比更低（2.73% vs 11.43%；p<0.05）。与对照组相比，研究组的左心房面积更大（28.33（±7.50）vs 21.26（±2.79）cm²；p<0.001），左心室射血分数更低（54.85（±9.14）vs 58.17（±6.40）；p<0.05）。男性的PWTF（4801.6（±3695.4）vs 4127.8（±3689.6）mcV*ms；p=0.049）高于女性。在多变量逻辑回归分析中，与AF患者IS发生显著相关的预测因素为：更高的PWDV₁值（95%CI：1.02 - 1.08，p<0.001）、Pmax（95%CI：0.90 - 0.97，p<0.001）和左心室射血分数（95%CI：0.84 - 0.99，p=0.030）。
在IS患者中，观察到结构和电生理LAR的指标更高。LAR指标的严重程度在男女之间存在显著差异。
