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. 2021 Jan;26(1):e12801.
doi: 10.1111/anec.12801. Epub 2020 Sep 24.

Relation of atrial electromechanical delay to P-wave dispersion on surface ECG using vector velocity imaging in patients with hypertrophic cardiomyopathy

Hala Mahfouz Badran  1   2 , Ghada Soltan  1 , Eslam Eltahan  1 , Magdi H Yacoub  2   3 , Naglaa Faheem  1   2
Affiliations

Relation of atrial electromechanical delay to P-wave dispersion on surface ECG using vector velocity imaging in patients with hypertrophic cardiomyopathy

Hala Mahfouz Badran et al. Ann Noninvasive Electrocardiol. 2021 Jan.

Abstract

Objectives: Heterogeneity of structural and electrophysiologic properties of atrial myocardium is common characteristic in hypertrophic cardiomyopathy (HCM). We assessed the dispersion of atrial refractoriness on surface ECG using P-wave dispersion (PWD) and its relation to atrial electromechanical functions using vector velocity imaging (VVI) in HCM population.

Methods: Seventy-nine HCM patients (mean age: 43.7 ± 13 years, 67% male) were compared with 25 healthy individuals as control. P-wave durations, Pmax and Pmin , P-wave dispersion (PWD), and P terminal force (PTF) were measured from 12-lead ECG. LA segmental delay (TTP-d) and dispersion (TTP-SD) of electromechanical activation were derived from atrial strain rate curves.

Results: HCM patients had longer PR interval, PW duration, higher PWD, PTF, QTc compared to control (p < .001). HCM patients were classified according to presence of PWD into two groups, group I with PWD > 46 ms (n = 25) and group II PWD ≤ 46 ms (n = 54). Group I showed higher prevalence of female gender, higher PTF, QTc interval, left ventricular outflow tract (LVOT) obstruction, p < .01, LVOT gradient (p < .001), LV mass index (p < .01), E/E' (p < .01), and severe mitral regurgitation (p < .001). Moreover, PWD was associated with increased atrial electromechanical delay (TTP-d) and LA mechanical dyssynchrony (TTP-SD), p < .001. LA segmental delay and dispersion of electromechanical activation were distinctly higher among HCM patient.

Conclusion: PWD is simple ECG criterion, and it is associated with more severe HCM phenotype and LA electromechanical delay while PTF is linked only to atrial remodeling.

Keywords: atrial electromechanical functions; hypertrophic cardiomyopathy; left atrial electrical activity; vector velocity imaging.

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Conflict of interest statement

All authors declare that there is No conflict of interest.

Figures

FIGURE 1
FIGURE 1
Measurement of P‐wave duration from computer screen using caliper
FIGURE 2
FIGURE 2
Strain rate analysis in study population
FIGURE 3
FIGURE 3
Vector velocity imaging (VVI) of left atrium in HCM patient. LA εsys and SRsys measure LA reservoir function, SRe measures LA conduit function and SRa measures LA contractile function
FIGURE 4
FIGURE 4
ECG intervals in HCM subgroups
FIGURE 5
FIGURE 5
LA mechanical dysynchrony in HCM subgroups
FIGURE 6
FIGURE 6
Relation of PTF to left atrial volume index
See this image and copyright information in PMC

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