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Relationship between P wave peak time and coronary artery disease severity in non-ST elevation acute coronary syndrome

Beziehung zwischen der Zeit bis zum P-Wellen-Gipfel und dem Schweregrad der koronaren Herzkrankheit beim akuten Koronarsyndrom ohne ST-Hebung

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Abstract

Background

Early diagnosis of non-ST elevation acute coronary syndrome (NSTE-ACS) and prediction of the severity of current coronary artery disease (CAD) play a major role in patient prognosis. Electrocardiography has a unique value in the diagnosis and provides prognostic information on patients with NSTE-ACS. In the present study, we aimed to examine the relationship between P wave peak time (PWPT) and the severity of CAD in patients with NSTE-ACS.

Methods

A total of 132 consecutive patients (female: 35.6%; mean age: 60.1 ± 11.6 years) who were diagnosed with NSTE-ACS were evaluated retrospectively. Gensini scores (GSs) were used to define the angiographic characteristics of the coronary atherosclerotic lesions. The patients were divided into two groups according to the GS. The PWPT was defined as the duration between the beginning and the peak of the P wave, and R wave peak time (RWPT) was defined as the duration between the beginning of the QRS complex and the peak of the R wave.

Results

There were 59 (44.6%) patients in the high-GS group (GS ≥25 ) and 73 (55.3%) patients in the low-GS group (GS <25 ). Presence of diabetes mellitus, low left ventricular ejection fraction, and high RWPT and PWPT were identified as predictors of a high GS in the study population. There was no significant difference between the area under the curves of PWPT and RWPT for predicting the severity of CAD (0.663 vs. 0.623, respectively; p = 0.573).

Conclusion

The present study found that both PWPT and RWPT on admission electrocardiography were associated with the severity and complexity of CAD in patients with NSTE-ACS.

Zusammenfassung

Hintergrund

Die frühe Diagnose eines akuten Koronarsyndroms ohne ST-Hebung („non-ST elevation acute coronary syndrome“ [NSTE-ACS]) und die Vorhersage des Schweregrads einer bestehenden koronaren Herzkrankheit (KHK) sind von wesentlicher Bedeutung für die Prognose des Patienten. Das Elektrokardiogramm (EKG) hat einen herausgehobenen diagnostischen Wert und liefert prognostische Informationen zu Patienten mit NSTE-ACS. In der vorliegenden Studie wurde die Beziehung zwischen der Zeit bis zum P‑Wellen-Gipfel („P wave peak time“ [PWPT]) und dem Schweregrad der KHK bei Patienten mit NSTE-ACS untersucht.

Methoden

Insgesamt 132 konsekutiv eingeschlossene Patienten (weiblich: 35,6 %; Durchschnittsalter: 60,1 ± 11,6 Jahre) mit Diagnose einer NSTE-ACS wurden retrospektiv betrachtet. Anhand des Gensini-Scores (GS) wurden die angiographischen Eigenschaften der koronaren atherosklerotischen Läsionen definiert. Gemäß dem GS wurden die Patienten in zwei Gruppen eingeteilt. Die PWPT war als die Zeitdauer vom Beginn bis zum Gipfel der P‑Welle definiert, und die Zeit bis zum R‑Wellen-Gipfel („R wave peak time“ [RWPT]) als die Dauer vom Beginn des QRS-Komplexes bis zum Gipfel der R‑Welle.

Ergebnisse

Die Gruppe mit hohem GS (GS ≥25) umfasste 59 (44,6 %) Patienten, die Gruppe mit niedrigem GS (GS <25) umfasste 73 (55,3 %) Patienten. Das Vorliegen eines Diabetes mellitus, eine geringe linksventrikuläre Ejektionsfraktion und eine hohe RWPT sowie PWPT wurden als Prädiktoren eines hohen GS in der Studienpopulation identifiziert. Es fand sich kein signifikanter Unterschied zwischen den Flächen unter den Kurven von PWPT und RWPT für die Vorhersage des KHK-Schweregrads (0,663 vs. 0,623; p = 0,573).

Schlussfolgerung

In der vorliegenden Studie war sowohl die PWPT als auch die RWPT im Aufnahme-EKG mit dem Schweregrad und der Kompliziertheit der KHK bei Patienten mit NSTE-ACS assoziiert.

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Authors and Affiliations

  1. Depertament of Cardiology, Umraniye Training and Research Hospital, University of Medical Sciences, Umraniye, Turkey

    Emrah Bayam, Ersin Yıldırım, Muzaffer Kahyaoğlu, Yusuf Yılmaz, Murat Selcuk & Cihangir Uyan

  2. Depertament of Cardiology, Faculty of Medicine, Hitit University, Buharaevler Mah. Buhara 25. Sok. No. 1 /A Daire: 22, Çorum, Turkey

    Macit Kalçık MD

  3. Depertament of Cardiology, Kartal Kosuyolu High Specialty Training and Research Hospital, University of Medical Sciences, Kartal, Turkey

    Ahmet Karaduman, Semih Kalkan, Ahmet Güner & Ayhan Küp

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  1. Emrah Bayam
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Correspondence to Macit Kalçık MD.

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Conflict of interest

E. Bayam, E. Yıldırım, M. Kalçık, A. Karaduman, S. Kalkan, A. Güner, A. Küp, M. Kahyaoğlu, Y. Yılmaz, M. Selcuk and C. Uyan declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Bayam, E., Yıldırım, E., Kalçık, M. et al. Relationship between P wave peak time and coronary artery disease severity in non-ST elevation acute coronary syndrome. Herz 46, 188–194 (2021). https://doi.org/10.1007/s00059-019-04859-1

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  • DOI: https://doi.org/10.1007/s00059-019-04859-1

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