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Electrocardiographic Morphology-Voltage-P-Wave-Duration (MVP) Score to Select Patients for Continuous Atrial
Lucas Yixi Xing1, Søren Zöga Diederichsen2, Søren Højberg3
1Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital - Roskilde, Roskilde, Denmark.
Abstract:
Morphology-voltage-P-wave-duration (MVP) score combining P-wave duration (PWD), P-wave voltage in lead I (PWVI), and interatrial block (IAB) has been demonstrated to predict atrial fibrillation (AF). Therefore, this study aimed to examine MVP score and its P-wave components as potential predictors of AF screening effects on stroke prevention. This was a secondary analysis of the LOOP Study (Atrial Fibrillation detected by Continuous ECG Monitoring using Implantable Loop Recorder to prevent Stroke in High-risk Individuals) which randomized older persons (aged 70 to 90 years) with additional stroke risk factors to either continuous monitoring with implantable loop recorder and anticoagulation upon detection of AF episodes ≥6 minutes (the intervention group), or usual care. A total of 5,759 participants were included in the present analysis, where PWD, PWVI, and IAB were determined through a computerized analysis of 12-lead electrocardiogram and further employed to calculate baseline MVP score (0 to 6) for each participant. In total, 305 (5.3%) had stroke or systemic embolism during follow-up, with a higher risk in the group with MVP score 5 to 6 than those having score 0 to 2 (hazard ratio (HR) 1.54 [95% confidence interval (CI) 1.01 to 2.35]). This risk increase was mainly upheld by participants with IAB (HR 1.62 [95% CI 1.11 to 2.36] for IAB vs no IAB) and with longer PWD (HR 1.37 [95% CI 1.07 to 1.75] for >110 vs ≤110 ms). Compared with usual care, implantable loop recorder screening did not significantly reduce the risk of stroke or systemic embolism in any MVP risk categories (HR 0.80 [95% CI 0.60 to 1.08] for MVP score 0 to 2, 0.54 [95% CI 0.16 to 1.85] for MVP score 3 to 4, and 0.89 [95% CI 0.35 to 2.25] for MVP score 5 to 6; pinteraction = 0.78). In conclusion, a higher MVP score was associated with an increased stroke risk, but it did not demonstrate an association with effects of AF screening on stroke prevention. These findings should be considered hypothesis-generating and warrant further study.
Insights
The Morphology-voltage-P-wave-duration (MVP) score predicts stroke risk in individuals screened for atrial fibrillation (AF). However, the MVP score did not show an association with the effectiveness of AF screening in preventing strokes.
Area of Science:
- Cardiology
- Electrocardiography
- Stroke Prevention
Background:
- The Morphology-voltage-P-wave-duration (MVP) score, combining P-wave duration (PWD), P-wave voltage in lead I (PWVI), and interatrial block (IAB), is a known predictor of atrial fibrillation (AF).
- Early detection and management of AF can mitigate stroke risk.
Purpose of the Study:
- To investigate the MVP score and its components (PWD, PWVI, IAB) as predictors of AF screening effectiveness on stroke prevention.
- To analyze the association between MVP score and stroke/systemic embolism risk within the context of AF screening.
Main Methods:
- Secondary analysis of the LOOP Study involving 5,759 participants aged 70-90 years with stroke risk factors.
- Participants were randomized to continuous monitoring with an implantable loop recorder (ILR) and anticoagulation upon AF detection or usual care.
- Baseline MVP score was calculated using computerized 12-lead ECG analysis of PWD, PWVI, and IAB.
Main Results:
- A higher MVP score (5-6) was associated with increased stroke/systemic embolism risk compared to lower scores (0-2) (HR 1.54).
- Interatrial block (IAB) and longer PWD (>110 ms) were key contributors to this elevated risk.
- ILR screening did not significantly reduce stroke risk across different MVP score categories compared to usual care (pinteraction = 0.78).
Conclusions:
- The MVP score is associated with increased stroke risk, particularly in individuals with IAB and longer PWD.
- AF screening using ILR did not demonstrate a significant benefit in stroke prevention across various MVP risk categories.
- Further research is warranted to explore the predictive value of the MVP score and its role in AF management strategies.
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