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Updated: Jun 13, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Positive T wave in lead aVR is associated with left atrial and ventricular function and cardiac outcomes in heart
Bektas Murat1, Selda Murat2, Fatih Aydın1
1Eskisehir City Hospital, Department of Cardiology, Eskisehir, Turkey.
Background:
Heart failure with preserved ejection fraction (HFpEF) accounts for a significant proportion of heart failure cases and is associated with high morbidity and mortality. While echocardiography plays a central role in HFpEF assessment, the prognostic value of electrocardiographic (ECG) findings, particularly in lead aVR, remains underexplored. This study investigates the relationship between a positive T wave in lead aVR (TaVR) and left atrial (LA) and left ventricular (LV) function, as well as its prognostic significance in HFpEF patients.
Methods:
This retrospective study included 231 HFpEF patients diagnosed according to ESC guidelines. Patients underwent comprehensive echocardiography and 12‑lead ECG evaluation. Positive TaVR was defined as a T-wave amplitude ≥1 mm in lead aVR. LA and LV functions were assessed using LA reservoir strain (LASr) and LV global longitudinal strain (GLS), respectively. Multivariate Cox regression and Kaplan-Meier survival analyses were performed to evaluate the prognostic significance of TaVR.
Results:
Positive TaVR was observed in 34.6 % of patients and was associated with impaired LASr (15.02 ± 6.65 % vs. 17.78 ± 9.10 %, p = 0.023) and LV GLS (-13.66 ± 3.49 % vs. -15.19 ± 3.02 %, p = 0.001). Positive TaVR independently predicted 1-year all-cause mortality (HR = 6.02, p < 0.001) and 6-month all-cause mortality (HR = 9.67, p < 0.001). Patients with positive TaVR had higher hospitalization rates and worse clinical outcomes.
Conclusion:
Positive TaVR is associated with LA dysfunction, LV remodeling, and poor prognosis in HFpEF. Incorporating this ECG parameter into routine clinical assessments could enhance risk stratification and guide management strategies for HFpEF patients.
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