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Published on: February 26, 2013
P-wave parameters and their association with thrombi and spontaneous echo contrast in the left atrial appendage
Fabienne Kreimer1, Julian Felix Backhaus1, Christos Krogias2
1Cardiology and Rhythmology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.
Insights
Abnormal P-wave parameters, including duration and dispersion, are linked to thrombus and spontaneous echo contrast in the left atrial appendage. These findings help identify patients at high risk for thromboembolic events.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Thrombus and spontaneous echo contrast (SEC) in the left atrial appendage (LAA) increase thromboembolic risk.
- P-wave abnormalities on electrocardiography (ECG) may indicate atrial dysfunction.
- The relationship between P-wave parameters and LAA thrombus/SEC requires further investigation.
Purpose of the Study:
- To determine the prevalence of abnormal P-wave parameters in patients with LAA thrombus/SEC.
- To identify specific P-wave parameters associated with thrombus and SEC formation in the LAA.
- To assess the potential of P-wave analysis for risk stratification in thromboembolic events.
Main Methods:
- Retrospective analysis of transoesophageal echocardiography (TEE) and ECG data.
- Inclusion of patients with confirmed LAA thrombus/SEC and a control group with high CHA2DS2-VASc scores.
- Detailed ECG analysis focusing on P-wave duration, P-wave dispersion, and interatrial block.
Main Results:
- A high prevalence of abnormal P-wave parameters was observed in patients with LAA thrombus/SEC (7.4% of 4062 TEEs).
- Significant associations were found between LAA thrombus/SEC and prolonged P-wave duration (>118 ms, OR 3.418), increased P-wave dispersion (>40 ms, OR 2.521), and advanced interatrial block (OR 1.431).
- No significant difference in mean CHA2DS2-VASc score was noted between the thrombus/SEC and control groups.
Conclusions:
- Several P-wave parameters are significantly associated with the presence of thrombi and SEC in the LAA.
- These P-wave abnormalities may serve as indicators for increased risk of thromboembolic events, particularly in patients with embolic stroke of undetermined source.
- P-wave analysis could be a valuable, non-invasive tool for identifying high-risk individuals.
Background:
The aim of this study was to examine the prevalence of abnormal P-wave parameters in patients with thrombus and/or spontaneous echo contrast (SEC) in the left atrial appendage (LAA), and to identify P-wave parameters particularly associated with thrombus and SEC formation.
Hypothesis:
We presume a significant relationship of P-wave parameters with thrombi and SEC.
Methods:
All patients in whom a thrombus or SEC was detected in the LAA on transoesophageal echocardiography were included in this study. Patients at risk (CHA2DS2-VASc Score ≥3) and routine transoesophageal echocardiography to exclude thrombi served as the control group. A detailed ECG analysis was performed.
Results:
Of a total of 4062 transoesophageal echocardiographies, thrombi and SEC were detected in 302 patients (7.4%). Of these patients, 27 (8.9%) presented with sinus rhythm. The control group included 79 patients. There was no difference in mean CHA2DS2-VASc score in the two groups (p = .182). A high prevalence of abnormal P-wave parameters was detected in patients with thrombus/SEC. Indicators for the presence of thrombi or SEC in the LAA were P-wave duration >118 ms (Odds ratio (OR) 3.418, Confidence interval (CI) 1.522-7.674, p < .001), P-wave dispersion >40 ms (OR 2.521, CI 1.390-4.571, p < .001) and advanced interatrial block (OR 1.431, CI 1.033-1.984, p = .005).
Conclusion:
Our study revealed that several P-wave parameters are associated with thrombi and SEC in the LAA. The results may help identify patients who are at particularly high risk for thromboembolic events (e.g., in patients with embolic stroke of undetermined source).
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