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Published on: June 10, 2025
Prognostic value of electrocardiographic phenotypes based on conduction intervals and waveform amplitudes in acute
Masamichi Yano1, Yasuyuki Egami1, Noriyuki Kobayashi1
1Division of Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan.
Insights
Electrocardiogram abnormalities, especially those indicating atrial dysfunction like abnormal P-wave morphology, predict poor outcomes in acute anterior myocardial infarction patients after PCI. These findings highlight ECG
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Electrocardiogram (ECG) abnormalities in acute anterior myocardial infarction (MI) may indicate myocardial damage extent.
- Prognostic significance of ECG findings post-percutaneous coronary intervention (PCI) is not fully understood.
Purpose of the Study:
- To investigate the prognostic value of ECG parameters in patients with acute anterior MI undergoing PCI.
- To identify distinct ECG phenotypes and their association with adverse clinical outcomes.
Main Methods:
- Hierarchical cluster analysis of ECG parameters (P-wave duration, amplitude, PQ interval, QRS duration, QTc) in 426 patients undergoing emergent PCI for acute anterior MI.
- Primary outcome: composite of heart failure hospitalization and all-cause mortality.
- Phenotype comparison using Kaplan-Meier analysis and ROC curve analysis for optimal cut-off values.
Main Results:
- Four distinct ECG phenotypes were identified.
- Phenotype 3 (prolonged P-wave/PQ, low P-wave amplitude, wide QRS, prolonged QTc) showed the highest risk for the composite outcome.
- Phenotype 3 was associated with higher rates of atrial fibrillation, renal dysfunction, and multivessel coronary artery disease.
Conclusions:
- ECG markers of atrial dysfunction, particularly abnormal P-wave morphology, are significantly linked to adverse outcomes in acute anterior MI patients post-PCI.
- These findings suggest ECG can identify high-risk patients needing closer monitoring or intervention.
Background:
In patients with acute anterior myocardial infarction (MI), abnormalities in conduction intervals and waveform amplitudes observed on admission electrocardiograms may reflect the extent of myocardial damage. However, their prognostic significance following percutaneous coronary intervention (PCI) remains incompletely understood.
Methods:
We enrolled consecutive patients undergoing emergent PCI for acute anterior MI and performed hierarchical cluster analysis based on P-wave duration (Pd), P-wave amplitude (PWA), PQ interval, QRS duration, and corrected QT interval (QTc). The primary outcome was a composite of heart failure hospitalization and all-cause mortality after PCI, which was compared across the identified phenogroups.
Results:
A total of 426 patients were included. Optimal cut-off values for Pd, PWA (leads II, V2, and V6), PQ interval, QRS duration, and QTc in predicting the composite outcome were determined via receiver operating characteristic (ROC) curve analysis. Hierarchical clustering identified four distinct electrocardiographic phenotypes: Phenotype 1 ("Normal morphology"), Phenotype 2 ("Low PWA and wide QRS"), Phenotype 3 ("Prolonged Pd/PQ, low PWA, wide QRS, and prolonged QTc"), and Phenotype 4 ("Prolonged Pd/PQ"). Kaplan-Meier analysis revealed that Phenotype 3 was significantly associated with the highest risk of the composite outcome. This phenotype also exhibited the highest prevalence of atrial fibrillation, along with more frequent renal dysfunction and multivessel coronary artery disease, suggesting the coexistence of pre-existing atrial dysfunction and ventricular electrical-structural abnormalities possibly related to ischemia.
Conclusions:
In patients with acute anterior MI undergoing PCI, electrocardiographic markers indicative of atrial dysfunction, particularly abnormal P-wave morphology, were significantly associated with adverse clinical outcomes.
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