Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Mar 31;2019(1):7.
doi: 10.21542/gcsp.2019.7.

Relationship of left atrial mechanics to electrical activity on surface electrocardiography in idiopathic dilated cardiomyopathy

Hala Mahfouz Badran  1   2   3 , Naglaa Faheem  1   2 , Kerolos Wagdy Wassely  1 , Magdi Yacoub  2   3   4
Affiliations

Relationship of left atrial mechanics to electrical activity on surface electrocardiography in idiopathic dilated cardiomyopathy

Hala Mahfouz Badran et al. Glob Cardiol Sci Pract. .

Abstract

Aim: (1) Assess left atrial (LA) mechanics and electromechanical delay in patients with idiopathic dilated cardiomyopathy (IDCM), and (2) examine the relationship between atrial electromechanical delay and atrial electrical activity [P-wave duration, P-wave dispersion (PWD) and P terminal force (PTF)] on surface ECG. Methods: 73 IDCM patients (age 36 ± 17 years); 63% men,25 age & sex matched healthy subjects were studied. LA atrial electromechanical delay & mechanics (εsys, SRsys, SRe, SRa) were measured with 2D-strain. From 12-lead electrocardiograms, P-wave duration, PWD and PTF calculated. Results: Reservoir, conduit and contractile functions were predominantly reduced compared to control (P < 0.001). Intra-atrial electromechanical delay was 88.9 ± 84.6 in IDCM versus 27.4 ± 16.5 in control (P < 0.0001). In IDCM, PWD (52.89 ± 15), Pmax(98 ± 17.5) and PTF(58.2 ± 36) were significantly increased compared to control (36.20 ± 8.9, 79 ± 9.9, 25.22 ± 8.76) respectively (P < 0.0001). A positive correlation was detected between intra-atrial electromechanical delay and PWD &PTF (r = 0.5, P < 0.0001). By stepwise multiple linear regression analyses, LA reservoir function (LA εsys) [β = 0.754; CI at 95%:0.356-0.780, P < 0.001] and LA volume [β = 0.743; CI 95%:0.423-0.75, P < 0.001], and PWD [β=0.848; CI 95%:0.311-0.644, P < 0.0001], and PTF [β = 0.927; CI 95%: 0.357-0.722, P < 0.0001] are independent predictors for LA electromechanical delay in IDCM. Conclusion: In addition to altered LA mechanics, atrial electromechanical delay gets longer in IDCM and is correlated with PWD and PTF. Atrial electrical dispersion on surface ECG could be early index of LA dysfunction that deserves further study.

PubMed Disclaimer

Figures

Figure 1A.
Figure 1A.. Measurements of LA εsys andSR obtained from four-chamber using VVI.
Peak positive LA εsys, and peak positive SRsys corresponds to reservoir function, LA peak positive early diastolic SR(SRe) corresponds to conduit function, peak positive atrial diastolic SR (SRa)corresponds to LA contractile function.
Figure 1B.
Figure 1B.. LA Strain and (top right) strain rate (bottom right) curve showing measurement of TTP from the beginning of P-wave on ECG to peak SRa in IDCM (TTP=116 ms).
Figure 2.
Figure 2.. Comparison of atrial electrical activity in IDCM & control.
Figure 3A.
Figure 3A.. Relation of PTF and LA electromechanical delay.
Figure 3B.
Figure 3B.. Relation of PWD to LA volume in IDCM.
Figure 3C.
Figure 3C.. Relation of PWD to LV end diastolic diameter.
Figure 3D.
Figure 3D.. Relation of PR interval to LAεsys.
Figure 3E.
Figure 3E.. Relation of PWD to LAεsys.
Figure 3F.
Figure 3F.. Relation of PTF to LAεsys.
Figure 3G.
Figure 3G.. Relation of PTF to LA diameter.
Figure 4.
Figure 4.. ROC curve for optimal cutoff value of PWD & PTF to discriminate electromechanical delay in IDCM.
See this image and copyright information in PMC

References

    1. Dilaveris PE, Gialafos EJ, Andrikopoulos GK, Richter DJ, Papanikolaou V, Poralis K, Gialafos JE. Clinical and electrocardiographic predictors of recurrent atrial fibrillation. Pacing and Clinical Electrophysiology. 2000;23(3):352–358. doi: 10.1111/j.1540-8159.2000.tb06761.x . - PubMed
    1. Gialafos JE, Dilaveris PE, Gialafos EJ, Andrikopoulos GK, Richter DJ, Triposkiadis F, Kyriakidis MK. P wave dispersion: A valuable electrocardiographic marker for the prediction of paroxysmal lone atrial fibrillation. Annals of Noninvasive Electrocardiology. 1999;4(1):39–45. doi: 10.1111/j.1542-474X.1999.tb00363.x. - DOI
    1. Sanders P, Morton JB, Davidson NC, Spence SJ, Vohra JK, Sparks PB, Kalman JM. Electrical remodeling of the atria in congestive heart failure: Electrophysiological and electroanatomic mapping in humans. Circulation. 2003;108(12):1461–1468. doi: 10.1161/01.CIR.0000090688.49283.67. - DOI - PubMed
    1. Acar G, Akcay A, Sayarlioglu M, Sokmen A, Sokmen G, Koroglu S, Gunduz M, ISpiroglu M, Tuncer C. Assessment of atrial conduction time in patients with familial Mediterranean fever. Pacing and Clinical Electrophysiology. 2009;32(3):308–313. doi: 10.1111/j.1540-8159.2008.02237.x. - DOI - PubMed
    1. Rein AJJT, O’Donnell CP, Colan SD, Marx GR. Tissue velocity Doppler assessment of atrial and ventricular electromechanical coupling and atrioventricular time intervals in normal subjects. Am J Cardiol. 2003;92(11):1347–1350. - PubMed

LinkOut - more resources