Diurnal variation of the P-wave dispersion in chronic ischemic heart diseases
Nesligül Yíldírím1, Serkan Topaloglu, Seher Bozboga
1Department of Cardiology, Zonguldak Karaelmas University, Kozlu, Zonguldak, Turkey. nesligul2004@hotmail.com
Insights
Patients with coronary heart disease show higher morning P-wave duration and dispersion, indicating potential timing for atrial conduction abnormalities and myocardial ischemia treatment.
Area of Science:
- Cardiology
- Electrophysiology
- Ischemic Heart Disease
Background:
- Electrocardiographic indices like maximum P-wave duration (Pmax) and P-wave dispersion (PD) are utilized for detecting atrial conduction disorders and estimating atrial fibrillation risk.
- Myocardial ischemia exhibits diurnal variations, particularly in patients with significant coronary artery lesions.
Purpose of the Study:
- To investigate the diurnal variation of atrial conduction abnormalities in patients with coronary heart disease.
- To assess if Pmax and PD show temporal patterns related to myocardial ischemia.
Main Methods:
- Forty-eight typical angina patients were categorized into two groups based on coronary angiography: Group 1 (significant coronary artery stenosis, n=28) and Group 2 (normal coronary arteries, n=20).
- P-wave dispersion (PD) was calculated as the difference between maximum P-wave duration (Pmax) and minimum P-wave duration (Pmin).
- Diurnal variations in Pmax, Pmin, and PD were compared between and within groups.
Main Results:
- Group 1 exhibited significantly higher morning Pmax (112±1 ms) and PD (54±9 ms) compared to Group 2 (P<0.001 and P<0.05, respectively).
- In Group 1, morning Pmax and PD were significantly elevated compared to afternoon and night values (P<0.001).
- No significant diurnal variations in Pmax, Pmin, or PD were observed in Group 2.
Conclusions:
- Coronary heart disease patients demonstrate elevated morning Pmax and PD.
- These findings suggest that morning Pmax and PD may be crucial for predicting the timing of atrial conduction disorders in myocardial ischemia.
- The results may inform treatment strategies for managing atrial conduction abnormalities in ischemic heart disease.
Objective:
Electrocardiographic indices like maximum P-wave duration (P(max)) and P-wave dispersion (PD) can be used to detect patients with atrial conduction disorders, myocardial ischemia and those at risk for atrial fibrillation. Considering the diurnal variation of ischemia in patients with significant coronary lesions, this study was designed to investigate the diurnal variation of eventual atrial conduction abnormalities.
Methods:
Forty-eight patients (31 male) with typical angina were grouped according to coronary angiography results as group 1 - 70% or more luminal reduction in at least one of the coronary arteries (n=28), and group 2 - normal coronary arteries (n=20). The difference between the P(max) and minimum P-wave durations (P(min)) is designated as PD. The diurnal P(max), P(min) and PD values were compared between and within the groups.
Results:
The morning P(max) value of group 1 was significantly higher than the value of group 2 (112+/-1 vs. 102+/-1 ms, P<0.001). The morning PD of group 1 was significantly higher than that of group 2 (54+/-9 vs. 48+/-1 ms, P<0.05). The morning P(max) of group 1 (112+/-1 ms) was significantly higher than its afternoon (102+/-9 ms) and night (102+/-1 ms) values (P<0.001). The morning PD of group 1 (54+/-9 ms) was higher than the afternoon (40+/-10 ms) and night (43+/-9 ms) PD (P<0.001). No significant difference was observed between the P(max), P(min) and PD values in group 2 (P>0.05).
Conclusion:
This study demonstrated that coronary heart disease patients have higher morning P(max) and PD values that may be important regarding prediction of timing and treatment of atrial conduction disorders in myocardial ischemia.
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