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The acute effect of percutaneous mitral balloon valvuloplasty on atrial electromechanical delay and P-wave dispersion in patients with mitral stenosis

Akute Wirkung perkutaner Mitralklappen-Ballondilatation auf atriale elektromechanische Verzögerung und P-Wellen-Dispersion bei Patienten mit Mitralstenose

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Abstract

Background and aim of the study

The predisposition to atrial fibrillation (AF) in mitral stenosis (MS) has been demonstrated with several electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (atrial electromechanical delay). Despite the improvement in P-wave dispersion after percutaneous mitral balloon valvuloplasty (PMBV), the changes in echocardiographic parameters related to AF risk are unknown. In this study we aimed to investigate the acute effect of PMBV on atrial electromechanical delay (EMD) assessed by tissue Doppler echocardiography in addition to electrocardiographic parameters.

Materials and methods

This single-center study consisted of 30 patients with moderate or severe MS (23 females and seven males, aged 36.5 ± 8.5 years, with a mean MVA of 1.1 ± 0.2 cm2) who underwent successful PMBV without complication at our clinic and 20 healthy volunteers from hospital staff as a control group (16 females and four males, aged 35.4 ± 6 years). We compared the two groups in regard to clinical, electrocardiographic and echocardiographic features. The patients with MS were also evaluated after PMBV within 72 h of the procedure. The P-wave dispersion was calculated from12-lead ECG. Interatrial and intra-atrial EMDs were measured by tissue Doppler echocardiography. These ECG and echocardiographic parameters after PMBV were compared with previous values.

Results

The maximum P-wave duration (138 ± 15 vs. 101 ± 6 ms, p < 0.01), PWD (58 ± 18 vs 23 ± 4, p < 0.01), the interatrial (55 ± 16 vs 36 ± 11 ms, p < 0.01) and left-sided intra-atrial EMD (40 ± 11 vs 24 ± 12 ms, p < 0.01) were higher in patients with MS than in healthy subjects. The left atrial (LA) diameter, LA volume and LA volume index had positive association with the interatrial (r = 0.5, p < 0.01; r = 0.5, p < 0.01 and r = 0.5, p < 0.01, respectively) and left-sided intra-atrial EMD (r = 0.5, p < 0.01; r = 0.4, p < 0.01; r = 0.4, p < 0.01 respectively). After PMBV, the interatrial (55 ± 16 vs. 40 ± 11 ms, p < 0.01) and left-sided intra-atrial EMD (40 ± 11 vs 31 ± 10, p < 0.01) showed significant improvement compared to previous values. There was also a statistically significant difference in maximum P-wave duration and PWD between pre-and post-PMBV (138 ± 15 vs 130 ± 14, p < 0.01, and 58 ± 18 vs 49 ± 16, p < 0.01, respectively).

Conclusions

Our study shows that PMBV has a favorable effect on the electrocardiographic and echocardiographic parameters related with AF risk in patients with MS.

Zusammenfassung

Hintergrund und Ziel der Studie

Die Prädisposition zum Vorhofflimmern (VF) bei Mitralstenose (MS) ist an verschiedenen elektrokardiographischen (vermehrte P-Wellen-Dispersion) und echokardiographischen Parametern [atriale elektromechanische Verzögerung („electromechanical delay“, EMD)] nachgewiesen worden. Trotz der Besserung der P-Wellen-Dispersion (PWD) nach perkutaner Mitralklappen-Ballondilatation („percutaneous mitral balloon valvuloplasty“, PMBV) sind die Veränderungen echokardiographischer Parameter, die in Bezug zum VF-Risiko stehen, nicht bekannt. In der vorliegenden Studie war es Ziel, die akute Wirkung der PMBV auf die atriale EMD zu untersuchen, welche durch Gewebedopplerechokardiographie und elektrokardiographische Parameter bestimmt wurde.

Material und Methoden

An der Einzelzenterstudie nahmen 30 Patienten mit mittelgradiger oder schwerer MS teil [23 Frauen, 7 Männer, Alter: 36,5±8,5 Jahre, mittlere Mitralklappenöffnungsfläche („mitral valve area“, MVA): 1,1±0,2 cm2], bei denen eine PMBV erfolgreich komplikationslos in unserer Klinik durchgeführt wurde, sowie 20 gesunde Probanden des Krankenhauspersonals als Kontrollgruppe (16 Frauen, 4 Männer, Alter: 35,4±6 Jahre). Wir verglichen die beiden Gruppen im Hinblick auf klinische, elektrokardiographische und echokardiographische Merkmale. Innerhalb von 72 h nach der PMBV wurden die Patienten mit MS nachuntersucht. Die PWD wurde anhand des 12-Kanal-EKG berechnet. Gewebedopplerchokardiographisch erfolgte die Messung der interatrialen und intraatrialen EMD. Diese EKG- und echokardiographischen Parameter nach PMBV wurden mit den vorherigen Werten verglichen.

Ergebnisse

Maximale P-Wellen-Dauer (138 ± 15 vs. 101 ± 6 ms, p < 0,01), PWD (58 ± 18 vs. 23 ± 4, p < 0,01), interatriale (55 ± 16 vs. 36 ± 11 ms, p < 0,01) und linksseitige intraatriale EMD (40 ± 11 vs. 24 ± 12 ms, p < 0,01) waren bei den Patienten mit MS höher als bei den Gesunden. Der linksatriale (LA-)Durchmesser, das LA-Volumen und der LA-Volumenindex waren positiv mit der interatrialen (r = 0,5, p < 0,01; r = 0,5, p < 0,01 bzw. r = 0,5, p < 0,01) und linksseitigen intraatrialen EMD (r = 0,5, p < 0,01; r = 0,4, p < 0,01 bzw. r = 0,4, p < 0,01) assoziiert. Nach PMBV wiesen interatriale (55 ± 16 vs. 40 ± 11 ms, p < 0,01) und linksseitige intraartriale EMD (40 ± 11 vs. 31 ± 10, p < 0,01) eine signifikante Verbesserung im Vergleich zu vorher auf. Außerdem war der Unterschied bei maximaler P-Wellen-Dauer und PWD vor und nach PMBV statistisch signifikant (138 ± 15 vs. 130 ± 14, p < 0,01 bzw. 58 ± 18 vs. 49 ± 16, p < 0,01).

Fazit

Die vorliegende Studie zeigt, dass eine PMBV sich günstig auf EKG- und echokardiographische Parameter auswirkt, die in Bezug zum VF-Risiko bei Patienten mit MS stehen.

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On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Cardiology, Turkey Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey

    B. Demirkan M.D., Y. Guray, U. Guray, M.R. Ege, H.L. Kisacik, H. Sasmaz & S. Korkmaz

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  1. B. Demirkan M.D.
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  2. Y. Guray
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  3. U. Guray
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Correspondence to B. Demirkan M.D..

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Demirkan, B., Guray, Y., Guray, U. et al. The acute effect of percutaneous mitral balloon valvuloplasty on atrial electromechanical delay and P-wave dispersion in patients with mitral stenosis. Herz 38, 210–215 (2013). https://doi.org/10.1007/s00059-012-3672-3

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  • DOI: https://doi.org/10.1007/s00059-012-3672-3

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