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CC BY 4.0 · Arq Neuropsiquiatr 2022; 80(09): 877-884
DOI: 10.1055/s-0042-1755322
Original Article

Evaluation of electrocardiographic P wave parameters in predicting long-term atrial fibrillation in patients with acute ischemic stroke

Avaliação dos parâmetros eletrocardiográficos da onda P na predição de fibrilação atrial de longa duração em pacientes com acidente vascular cerebral isquêmico agudo
Tufan Çinar 
1   Health Sciences University, Sultan II, Abdülhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
,
Mert İlker Hayiroğlu 
2   Health Sciences University, Dr. Siyami Ersek Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
,
Murat Selçuk 
1   Health Sciences University, Sultan II, Abdülhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
,
Göksel Cinier 
2   Health Sciences University, Dr. Siyami Ersek Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
,
Vedat Çiçek 
1   Health Sciences University, Sultan II, Abdülhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
,
Selami Doğan 
1   Health Sciences University, Sultan II, Abdülhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
,
Şahhan Kiliç 
1   Health Sciences University, Sultan II, Abdülhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
,
Süha Asal 
1   Health Sciences University, Sultan II, Abdülhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
,
Murat Mert Atmaca 
3   Health Sciences University, Sultan II, Abdülhamid Han Training and Research Hospital, Department of Neurology, Istanbul, Turkey.
,
Ahmet Lütfullah Orhan 
1   Health Sciences University, Sultan II, Abdülhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
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Abstract

Background Electrocardiographic parameters, such as P wave peak time (PWPT), P wave duration (PWD), and P wave amplitude in lead DI, have been utilized to assess left atrial anomalies linked to the development of atrial fibrillation (AF) in different cohort settings.

Objective To compare electrocardiographic parameters, such as P waves, in predicting long-term AF risk in acute ischemic stroke cases.

Methods The data of 231 consecutive acute ischemic stroke cases were retrospectively collected. Two independent cardiologists interpreted the electrocardiography recordings for PWPT, PWD, and P wave amplitude in lead DI. The median follow-up study period was 16 (interquartile range [IQR]: 11–24) months.

Results In total, AF was detected in 43 (18.6%) cases. All studied P wave parameters were found to be statistically significant in cases with AF. Based on multivariable logistic regression analysis, dementia, left atrium volume index, PWD (razão de chances [RC]: 1.11; 95% confidence interval [CI]: 1.058–1.184; p = 0.003), PWPT in lead DII (RC: 1.030; 95%CI: 1.010–1.050; p = 0.003), and advanced interatrial block morphology were independent predictors of long-term AF. P wave duration had the highest area under the curve value, sensitivity, and specificity for long-term AF in such cases compared with the other P wave parameters.

Conclusions Our head-to-head comparison of well-known P wave parameters demonstrated that PWD might be the most useful P wave parameter for long-term AF in acute ischemic stroke cases.

Resumo

Antecedentes Parâmetros eletrocardiográficos, como tempo de pico da onda P (PWPT, na sigla em inglês), duração da onda P (PWD, na sigla em inglês) e amplitude da onda P na derivação DI, têm sido utilizados para avaliar anomalias atriais esquerdas ligadas ao desenvolvimento de fibrilação atrial (FA) em diferentes cenários de coortes.

Objetivo Comparar os parâmetros eletrocardiográficos destas ondas P na predição do risco de FA de longo prazo em casos de acidente vascular cerebral (AVC) isquêmico agudo.

Métodos Os dados de 231 casos consecutivos de AVC isquêmico agudo foram coletados retrospectivamente. Dois cardiologistas independentes interpretaram os registros eletrocardiográficos para PWPT, PWD e amplitude da onda P na derivação DI. O período médio do estudo de acompanhamento foi de 16 (intervalo interquartil [IQR, na sigla em inglês]: 11–24) meses.

Resultados No total, FA foi detectada em 43 (18,6%) casos. Todos os parâmetros da onda P estudados foram considerados estatisticamente significativos nos casos com FA. Com base na análise de regressão logística multivariável, demência, índice de volume do átrio esquerdo, PWD (razão de chances [RC]: 1,112; intervalo de confiança [IC] 95%: 1,058–1,184; p = 0,003), PWPT na derivação DII (RC: 1,030; IC95%: 1,010–1,050; p = 0,003) e avançada morfologia do bloqueio interatrial foram preditores independentes de FA de longo prazo. A PWD teve a maior área sob o valor da curva, sensibilidade e especificidade para FA de longo prazo em tais casos em comparação com os outros parâmetros da onda P.

Conclusões Nossa comparação direta de parâmetros da onda P bem conhecidos demonstrou que a PWD pode ser o parâmetro da onda P mais útil para FA de longa duração em casos de AVC isquêmico agudo.

Keywords

p Wave - Reference Parameters - Electrocardiography - Ischemic Stroke

Palavras-chave

Onda p - Parâmetros de Referência Eletrocardiografia - AVC Isquêmico

Authors' Contributions

TÇ, MIH: conception; TÇ, MIH, MS, GÇ: design; MMA, ALO: supervision; SA, SD: fundings; MS, GÇ, VÇ, SA, SK, SD: materials; TÇ, MS, GÇ, VÇ, SA, SK, SD: data collection; MİH: analysis; TÇ, SA: literature review; TÇ: writer; All authors: critical review.




Publikationsverlauf

Eingereicht: 27. August 2021

Angenommen: 16. Oktober 2021

Artikel online veröffentlicht:
09. November 2022

© 2022. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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