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Published on: February 20, 2017
P-wave dispersion and left atrial volume index as predictors in heart failure
Rose Mary Ferreira Lisboa da Silva1, Nadya Mendes Kazzaz, Rosália Morais Torres
1Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil. roselisboa@uol.com.br
Insights
P-wave dispersion (PWD) did not predict cardiovascular events (CE) in heart failure (HF) patients. However, left atrial volume index (LAVi) independently predicted CE, with Chagas disease patients experiencing worse outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Research
Background:
- P-wave dispersion (PWD) and left atrial volume index (LAVi) are established predictors of cardiovascular events (CE).
- Assessing these markers is crucial for risk stratification in heart failure (HF) patients.
Purpose of the Study:
- To determine the prognostic significance of PWD and LAVi for CE occurrence in stable heart failure patients.
- To evaluate the predictive value of these indices in a prospective cohort.
Main Methods:
- A longitudinal prospective study included 78 stable heart failure patients (mean age 47.2 years, 52% male).
- Patients underwent clinical evaluation, electrocardiogram (ECG), and echocardiogram assessments.
- Follow-up duration was 26.5 months to monitor for cardiovascular events.
Main Results:
- Left atrial volume index (LAVi > 28 mL/m²) was identified as an independent predictor of CE (p=0.02).
- Patients with LAVi > 28 mL/m² had a significantly higher risk of events (Odds Ratio 14.4, p=0.00).
- Chagas disease etiology was also associated with worse outcomes (Odds Ratio 3.2, p=0.03), while PWD showed no correlation with CE.
Conclusions:
- Left atrial volume index (LAVi) is a significant independent predictor of cardiovascular events in heart failure patients.
- P-wave dispersion (PWD) does not appear to be a reliable predictor of CE in this population.
- Chagasic heart disease patients face a poorer prognosis, highlighting the need for tailored management strategies.
Background:
Studies have shown that P-wave dispersion (PWD) and left atrial volume index (LAVi) are predictors of cardiovascular events (CE).
Objective:
To verify the prognostic value of PWD and LAVi for the occurrence of CE in patients with heart failure (HF).
Methods:
This was a longitudinal prospective study of 78 consecutive patients with a mean age of 47.2 years, of which 52 were males. Patients had stable HF and underwent clinical evaluation, electrocardiogram and echocardiogram assessments, with a follow-up of 26.5 months.
Results:
The means of the variables were: 50 ms for PWD and 35.5 mL/m² for LAVi. Considering PWD > 40 ms and, as reference, LAVi > 28 mL/m², the positive predictive value of PWD was 87.5% and the negative predictive value was 76.9%. During follow-up, 21 patients had CE. There was an association between left atrial measurements, left ventricular volumes, ejection fraction and CE. There was no association between PWD and CE. At the multivariate analysis, the left atrium and LAVi were predictors of events (p = 0.00 and 0.02). Through the operating characteristic curve for the variable stable CE, areas of 0.80 and 0.69 were obtained for LAVi (p = 0.00) and LAVi > 28 mL/m² (p = 0.01). Survival curves (Kaplan-Meier) free of those events for LAVi > 28 mL/m² and for Chagas disease etiology showed an odds ratio of 14.4 (p = 0.00) and 3.2 (p = 0.03). There was no difference in outcome between patients with ischemic and nonischemic heart failure.
Conclusion:
PWD was not correlated to CE. LAVi was an independent predictor of CE, and chagasic patients showed worse outcomes.
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