Are P Wave and QT Dispersions Related to Severe Peripheral Artery Disease?

Abstract

BACKGROUND The aim of this study was to evaluate the relationship between P wave and QT dispersions (PWD and QTD) during the course of severe peripheral artery disease (PAD). MATERIAL AND METHODS We recruited 163 patients who underwent peripheral angiography (PA) between August 2011 and March 2017, and they were divided into 2 groups according to the severity of PAD on PA. PWD and QTD were investigated using 12-lead electrocardiograms. Group One consisted of patients diagnosed with <70% stenosis on PA, who eventually received medical treatment; Group Two consisted of patients diagnosed with ≥70% stenosis on PA, who eventually underwent surgery. RESULTS ROC curve analysis of the 2 groups demonstrated that PWD was significantly higher in Group Two (AUC: 0.913505; 95% confidence interval (CI): 0.859365 to 0.951788; p<0.0001). The Youden index showed that a cut-off PWD value of >35 msn predicted a peripheral artery stenosis of ≥70% with a sensitivity of 88.89% and a specificity of 85.37% (+LR: 6.07, -LR: 0.13). Moreover, QTD was significantly higher in Group Two (AUC: 0.884749; 95% CI: 0.825489 to 0.929391; p<0.0001). Youden index showed that a cut-off QTD value of >75 msn predicted a peripheral artery stenosis of ≥70% with a sensitivity of 76.54% and a specificity of 85.37% (+LR: 5.23, -LR: 0.27). Comparison of ROC curves showed no difference in terms of predicting peripheral artery stenosis of ≥70% between PWD and QTD (p=0.3308). CONCLUSIONS Interpreting PWD and QTD offers a non-invasive and cost-effective assessment method for detecting patients at high risk for coronary artery disease in the context of severe PAD.

Figure 1

ROC Curve analysis of P wave dispersion in patients in whom peripheral artery bypass surgery was performed (AUC: 0.913505; 95% confidence Interval: 0.859365 to 0.951788; p<0.0001).

Figure 2

Youden index showing that a cut-off P Wave Dispersion value of >35 msn predicted a peripheral artery stenosis of ≥70% with a sensitivity of 88.89% and a specificity of 85.37% (+LR: 6.07, −LR: 0.13).

Figure 3

ROC Curve analysis of QT dispersion in patients in whom peripheral artery bypass surgery was performed (AUC: 0,884749; 95% confidence interval: 0.825489 to 0.929391; p<0.0001).

Figure 4

Youden index showing that a cut-off QTD value of >70 msn predicted a peripheral artery stenosis of ≥70% with a sensitivity of 76.54% and a specificity of 85.37% (+LR: 5.23, −LR: 0.27).

Figure 5

Comparison of ROC curves of P wave dispersion (PWD) and QT dispersion (QTD) indicating that there was no difference in terms of predicting peripheral artery stenosis of ≥70% between PWD and QTD (p=0.3308).