Electrocardiographic P-wave peak time predicts significant ischemia in INOCA patients: A pilot study
Muhammet Salih Ateş1, Erdoğan Sökmen1
1Department of Cardiology, Kırşehir Ahi Evran Training and Research Hospital, Kırşehir, Turkey.
Insights
Prolonged P-wave peak time (PWPT) on ECGs is linked to myocardial ischemia in patients with non-obstructive coronary arteries (INOCA). This electrocardiographic marker, especially in lead DII, can help identify coronary microvascular dysfunction.
Area of Science:
- Cardiology
- Diagnostic Electrocardiography
- Ischemic Heart Disease
Background:
- Ischemia with non-obstructive coronary arteries (INOCA) poses diagnostic challenges, often linked to coronary microvascular dysfunction (CMD).
- Non-invasive electrocardiographic markers for predicting ischemia in INOCA patients are clinically significant.
- P-wave peak time (PWPT) is an electrocardiographic index reflecting atrial conduction, potentially related to ischemic pathophysiology.
Purpose of the Study:
- To investigate the association between P-wave peak time (PWPT) and myocardial ischemia in patients with INOCA.
- To evaluate PWPT as a non-invasive marker for identifying significant ischemia and coronary microvascular dysfunction (CMD) in INOCA.
Main Methods:
- Retrospective observational study of 444 INOCA patients undergoing coronary angiography and SPECT myocardial perfusion imaging (MPI).
- P-wave indices, including PWPT in leads DII and V1, were digitally measured.
- Multivariate logistic regression and ROC analysis were used to identify predictors of significant ischemia (>10%) and assess PWPT's discriminative power.
Main Results:
- Prolonged PWPT in leads DII and V1 was significantly associated with >10% reversible myocardial ischemia.
- PWPT-DII demonstrated strong discriminative power (AUC 0.82), outperforming PWPT-V1 (AUC 0.76).
- PWPT-DII, PWPT-V1, age, diabetes mellitus, and E/e' ratio were independent predictors of significant ischemia in multivariate analysis.
Conclusions:
- Elevated PWPT, particularly in lead DII, is independently associated with myocardial ischemia in INOCA patients.
- PWPT may serve as a valuable, non-invasive tool for risk stratification and early detection of CMD in INOCA.
- Integrating PWPT into ECG interpretation could enhance diagnostic capabilities for patients with normal coronary angiograms and ischemic symptoms.
Background:
Ischemia with non-obstructive coronary arteries (INOCA) represents a diagnostic and therapeutic challenge, often related to coronary microvascular dysfunction (CMD). Identifying non-invasive electrocardiographic markers that predict ischemia in this population remains a clinical priority. P-wave peak time (PWPT), reflecting atrial conduction delay, has been linked to ischemic pathophysiology.
Methods:
This retrospective, observational study included 444 patients who underwent coronary angiography with normal epicardial arteries followed by SPECT myocardial perfusion imaging (MPI) due to persistent anginal symptoms. Patients were classified into three groups based on the percentage of reversible left ventricular ischemia: <5 %, 5-10 %, and > 10 %. P-wave indices-including PWPT in leads DII and V1-were measured digitally by two independent observers. Multivariate logistic regression identified independent predictors of >10 % ischemia. ROC analysis assessed the discriminative power of PWPT.
Results:
PWPT-DII and PWPT-V1 were significantly prolonged in patients with >10 % ischemia (63 ± 8 ms and 58 ± 9 ms, respectively) compared to patients with <5 % ischemia (55 ± 7 ms and 50 ± 8 ms; both p < 0.001). PWPT-DII yielded an AUC of 0.82 (95 % CI 0.77-0.86), outperforming PWPT-V1 (AUC 0.76). In multivariate models, PWPT-DII (OR 1.15, 95 % CI 1.08-1.23), PWPT-V1 (OR 1.10, 95 % CI 1.03-1.17), age, diabetes mellitus, and E/e' ratio emerged as independent predictors of significant ischemia.
Conclusions:
Prolonged PWPT, particularly in lead DII, was observed to be independently associated with myocardial ischemia in INOCA. Incorporating PWPT into standard ECG interpretation may aid in risk stratification and early identification of CMD in patients with normal coronary angiograms but ongoing ischemic symptoms.
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