Heart and Vessels

, Volume 28, Issue 6, pp 690–695

Abnormal P-wave terminal force in lead V1 is associated with cardiac death or hospitalization for heart failure in prior myocardial infarction

  • Gang Liu
  • Akira Tamura
  • Kumie Torigoe
  • Yoshiyuki Kawano
  • Kazuhiro Shinozaki
  • Munenori Kotoku
  • Junichi Kadota
Original Article

Abstract

The aim of this study was to clarify the prognostic significance of P-wave terminal force in lead V1 (PTFV1) in patients with prior myocardial infarction (MI). We retrospectively examined 185 patients with prior MI. The primary end point was cardiac death or hospitalization for heart failure. Abnormal PTFV1 was defined as PTFV1 ≥ 40 mm × ms. During a follow-up period of 6.4 ± 2.9 years, 39 patients developed the primary end point. A Kaplan–Meier analysis showed a lower primary event-free rate in 79 patients with abnormal PTFV1 than in 106 patients with normal PTFV1 (P < 0.001). When we classified 79 patients with abnormal PTFV1 into 31 with a purely negative P wave in lead V1 and 48 with a biphasic negative P wave in lead V1, the primary event-free rate did not differ between the two groups of patients. A multivariate Cox regression analysis selected age (hazard ratio (HR) 1.09, 95 % confidence interval (CI) 1.04–1.14, P < 0.001), multivessel coronary disease (HR 2.33, 95 % CI 1.02–5.28, P = 0.04), and abnormal PTFV1 (HR 2.72, 95 % CI 1.24–5.99, P = 0.01) as independent predictors of the primary end point. In conclusion, abnormal PTFV1 is an independent predictor of cardiac death or hospitalization for heart failure in patients with prior MI. The analysis of P waves in lead V1 should provide useful prognostic information in patients with prior MI.

Keywords

P wave Myocardial infarction Prognosis 

References

  1. 1.
    Morris JJ, Estes EH, Whalen RE, Thompson HK, McIntosh HD (1964) P-wave analysis in valvular heart disease. Circulation 29:242–252PubMedCrossRefGoogle Scholar
  2. 2.
    Pohjola S, Siltanen P, Romo M (1979) The prognostic value of the P wave morphology in the discharge ECG in a 5-year follow-up study after myocardial infarction. Am Heart J 98:32–38PubMedCrossRefGoogle Scholar
  3. 3.
    Siltanen P, Pohjola-Sintonen S, Haapakoski J, Mäkijärvi M, Pajari R (1985) The mortality predictive power of discharge electrocardiogram after first acute myocardial infarction. Am Heart J 109:1231–1237PubMedCrossRefGoogle Scholar
  4. 4.
    Perkiomaki JS, Zareba W, Greenberg HM, Moss AJ (2002) Usefulness of standard electrocardiographic parameters for predicting cardiac events after acute myocardial infarction during modern treatment era. Am J Cardiol 90:205–209PubMedCrossRefGoogle Scholar
  5. 5.
    Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A (2009) Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 53:982–992PubMedCrossRefGoogle Scholar
  6. 6.
    Thygesen K, Alpert JS, White HD, Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M, Katus HA, Newby LK, Ravkilde J, Chaitman B, Clemmensen PM, Dellborg M, Hod H, Porela P, Underwood R, Bax JJ, Beller GA, Bonow R, Van der Wall EE, Bassand JP, Wijns W, Ferguson TB, Steg PG, Uretsky BF, Williams DO, Armstrong PW, Antman EM, Fox KA, Hamm CW, Ohman EM, Simoons ML, Poole-Wilson PA, Gurfinkel EP, Lopez-Sendon JL, Pais P, Mendis S, Zhu JR, Wallentin LC, Fernandez-Aviles F, Fox KM, Parkhomenko AN, Priori SG, Tendera M, Voipio-Pulkki LM, Vahanian A, Camm AJ, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Widimsky P, Zamorano JL, Morais J, Brener S, Harrington R, Morrow D, Lim M, Martinez-Rios MA, Steinhubl S, Levine GN, Gibler WB, Goff D, Tubaro M, Dudek D, Al-Attar N (2007) Universal definition of myocardial infarction. Circulation 116:2634–2653PubMedCrossRefGoogle Scholar
  7. 7.
    Heikkilä J, Luomamäki K (1970) Value of serial P wave changes in indicating left heart failure in myocardial infarction. Br Heart J 32:510–517PubMedCrossRefGoogle Scholar
  8. 8.
    Chandraratna PA, Hodges M (1973) Electrocardiographic evidence of left atrial hypertension in acute myocardial infarction. Circulation 47:493–498PubMedCrossRefGoogle Scholar
  9. 9.
    Heikkilä J, Hugenholtz PG, Tabakin BS (1973) Prediction of left heart filling pressure and its sequential change in acute myocardial infarction from the terminal force of the P wave. Br Heart J 35:142–151PubMedCrossRefGoogle Scholar
  10. 10.
    Forfang K, Stake G (1976) P wave terminal force and persisting ST elevations in chronic ischemic heart disease: prediction of left ventricular motility and diastolic pressure. Am Heart J 92:297–301PubMedCrossRefGoogle Scholar
  11. 11.
    Forrester JS, Diamond G, Chatterjee K, Swan HJ (1976) Medical progress: medical therapy of acute myocardial infarction by application of hemodynamic subsets (first of two parts). N Engl J Med 295:1356–1382PubMedCrossRefGoogle Scholar
  12. 12.
    Planer D, Mehran R, Witzenbichler B, Guagliumi G, Peruga JZ, Brodie BR, Dudek D, Möckel M, Reyes SL, Stone GW (2011) Prognostic utility of left ventricular end-diastolic pressure in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Am J Cardiol 108:1068–1074PubMedCrossRefGoogle Scholar
  13. 13.
    Crenshaw BS, Ward SR, Granger CB, Stebbins AL, Topol EJ, Califf RM, for the GUSTO-I trial investigators (1997) Atrial fibrillation in the setting of acute myocardial infarction: the GUSTO-I experience. J Am Coll Cardiol 30:406–413Google Scholar
  14. 14.
    Guntekin U, Gumrukcuoglu HA, Gunes Y, Gunes A, Simsek H, Sahin M, Sezen Y, Akdağ S, Tuncer M (2011) The effects of perindopril on QT duration and dispersion in patients with coronary slow flow. Heart Vessels 26:357–362PubMedCrossRefGoogle Scholar
  15. 15.
    Sutnick AI, Soloff LA (1962) Posterior rotation of the atrial vector: an electrocardiographic sign of left ventricular failure. Circulation 26:913–916PubMedCrossRefGoogle Scholar
  16. 16.
    Grossman JI, Delman AJ (1969) Serial P wave changes in acute myocardial infarction. Am Heart J 77:336–341PubMedCrossRefGoogle Scholar
  17. 17.
    Moller JE, Hillis GS, Oh JK, Seward JB, Reeder GS, Wright RS, Park SW, Bailey KR, Pellikka PA (2003) Left atrial volume: a powerful predictor of survival after acute myocardial infarction. Circulation 107:2207–2212PubMedCrossRefGoogle Scholar
  18. 18.
    Birkbeck JP, Wilson DB, Hall MA, Meyers DG (2006) P-wave morphology correlation with left atrial volumes assessed by 2-dimensional echocardiography. J Electrocardiol 39:225–229PubMedCrossRefGoogle Scholar
  19. 19.
    Tsao CW, Josephson ME, Hauser TH, O’Halloran TD, Agarwal A, Manning WJ, Yeon SB (2008) Accuracy of electrocardiographic criteria for atrial enlargement: validation with cardiovascular magnetic resonance. J Cardiovasc Magn Reson 10:7PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2012

Authors and Affiliations

  • Gang Liu
    • 1
  • Akira Tamura
    • 1
  • Kumie Torigoe
    • 1
  • Yoshiyuki Kawano
    • 1
  • Kazuhiro Shinozaki
    • 1
  • Munenori Kotoku
    • 1
  • Junichi Kadota
    • 1
  1. 1.Internal Medicine 2, Faculty of Medicine, Oita UniversityYufuJapan

Personalised recommendations