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P-wave durations from automated electrocardiogram analysis to predict atrial fibrillation and mortality in heart
Jiandong Zhou1, Andrew Li2, Martin Tan3
1School of Data Science, City University of Hong Kong, Hong Kong, China.
Insights
Automated P-wave duration measurements can predict new-onset atrial fibrillation (AF) and mortality in heart failure (HF) patients. Extreme P-wave durations (≤90 ms and ≥141 ms) are significant predictors of adverse outcomes.
Area of Science:
- Cardiology
- Electrocardiography
- Heart Failure Research
Background:
- P-wave indices are established predictors for atrial fibrillation (AF), stroke, and mortality.
- The predictive value of automated P-wave indices in heart failure (HF) remains underexplored.
Purpose of the Study:
- To investigate the predictive capability of automated P-wave indices for adverse outcomes in patients with heart failure (HF).
Main Methods:
- Included 2718 Chinese patients with HF but no prior AF, with baseline ECGs recorded between 2010-2016.
- Follow-up extended to December 2019, with a median follow-up of 4.8 years.
- Analyzed maximum P-wave durations for prediction of new-onset AF, stroke, cardiovascular mortality, and all-cause mortality.
Main Results:
- Over 4.8 years, 1150 patients developed AF, 339 stroke, 563 cardiovascular mortality, and 1972 all-cause mortality.
- Maximum P-wave durations ≤90 ms and ≥141 ms significantly predicted new-onset AF (HRs 1.17-1.52).
- Extreme P-wave durations also predicted cardiovascular mortality (HRs 1.18-1.50) and all-cause mortality (HRs 1.26-1.31).
Conclusions:
- Extreme maximum P-wave durations (≤90 ms and ≥141 ms) are significant predictors of new-onset AF in HF patients.
- These P-wave duration values also predict cardiovascular and all-cause mortality.
- Automated P-wave analysis offers valuable prognostic information in HF management.
Background:
P-wave indices have been used to predict incident atrial fibrillation (AF), stroke, and mortality. However, such indices derived from automated ECG measurements have not been explored for their predictive values in heart failure (HF). We investigated whether automated P-wave indices can predict adverse outcomes in HF.
Methods:
This study included consecutive Chinese patients admitted to a single tertiary centre, presenting with HF but without prior AF, and with at least one baseline ECG, between 1 January 2010 and 31 December 2016, with last follow-up of 31 December 2019.
Results:
A total of 2718 patients were included [median age: 77.4, interquartile range (IQR): (66.9-84.3) years; 47.9 males]. After a median follow-up of 4.8 years (IQR: 1.9-9.0 years), 1150 patients developed AF (8.8/year), 339 developed stroke (2.6/year), 563 developed cardiovascular mortality (4.3/year), and 1972 had all-cause mortality (15.1/year). Compared with 101-120 ms as a reference, maximum P-wave durations predicted new-onset AF at ≤90 ms [HR: 1.17(1.11, 1.50), P < 0.01], 131-140 ms [HR: 1.29(1.09, 1.54), P < 0.001], and ≥141 ms [HR: 1.52(1.32, 1.75), P < 0.001]. Similarly, they predicted cardiovascular mortality at ≤90 ms [HR: 1.50(1.08, 2.06), P < 0.001] or ≥141 ms [HR: 1.18(1.15, 1.45), P < 0.001], and all-cause mortality at ≤90 ms [HR: 1.26(1.04, 1.51), P < 0.001], 131-140 ms [HR: 1.15(1.01, 1.32), P < 0.01], and ≥141 ms [HR: 1.31(1.18, 1.46), P < 0.001]. These remained significant after adjusting for significant demographics, past co-morbidities, P-wave dispersion, and maximum P-wave amplitude.
Conclusions:
Extreme values of maximum P-wave durations (≤90 ms and ≥141 ms) were significant predictors of new-onset AF, cardiovascular mortality, and all-cause mortality.
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