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Diagnostic Utility of P-Wave Duration in Identifying Left Atrial Enlargement: Insights from the ELSA-Brasil Cohort

Ana Cecília de Sena Oliveira1, Vinicius Tostes Carvalho1, Marcelo Martins Pinto-Filho1

  • 1Faculdade de Medicina - Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil.

Arquivos Brasileiros De Cardiologia
|December 19, 2025
PubMed

Insights

P-wave duration has limited value in diagnosing left atrial enlargement (LAE). This electrocardiogram (ECG) measure is not recommended as a standalone criterion for identifying LAE due to poor diagnostic accuracy.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Biomarkers

Background:

  • Atrial cardiomyopathy includes left atrial enlargement (LAE), linked to adverse cardiovascular and neurocognitive outcomes.
  • P-wave duration (≥120 ms) on electrocardiogram (ECG) is a potential diagnostic criterion for LAE.
  • The diagnostic performance of P-wave duration for LAE requires further large-scale investigation.

Purpose of the Study:

  • To assess the correlation between P-wave duration and left atrial volume (LAV) measured by echocardiogram.
  • To determine the diagnostic accuracy of P-wave duration (≥120 ms) for identifying LAE.

Main Methods:

  • Cross-sectional analysis of the ELSA-Brasil cohort (n=2589) in sinus rhythm.
  • P-wave duration measured by ECG; LAE defined as LAV > 34 mL/m² by transthoracic echocardiogram (TTE).
  • Spearman's rank test for correlation; diagnostic metrics (sensitivity, specificity, PPV, NPV, likelihood ratios) and ROC curve analysis were performed.

Main Results:

  • A weak correlation was found between P-wave duration and LAV (Spearman's ρ = 0.120, p < 0.001).
  • Diagnostic accuracy metrics revealed limited performance: AUC = 0.557, Sensitivity = 0.296, Specificity = 0.811, PPV = 0.232, NPV = 0.856.

Conclusions:

  • P-wave duration exhibits limited diagnostic utility for identifying LAE.
  • The findings suggest that P-wave duration should not be used as a standalone criterion for diagnosing LAE.
Abstract

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