P wave morphology correlation with left atrial speckle tracking echocardiography in patients with primary mitral regurgitation / Ramy Sameh Helmi Doss ; Supervised Hussein Hassan Rizk , Sameh Wadie Bakhoum , Reham Mohamed Darweesh

Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Cardiology

Background: Although it is well-known that P wave abnormalities reflect left atrial (LA) enlargement, much less is known about its relation to LA function . LA Speckle tracking echocardiography (STE) is a promising tool for evaluation of phasic LA function. Objective: We investigate whether P wave indices are correlated to left atrial phasic function assessed by LA strain using STE in patients with chronic primary mitral regurgitation(MR). Results: Both strain and volumetric indices of LA function were significantly lower in MR group compared to controls. Both TPD and V1-NTF showed the best positive correlation with LA Vmin/BSA (u =0.65; P<0.001 and u =0.63 ; P<0.001 respectively) followed by LA VpreA/BSA (u =0.63; P <0.001 and u =0.61; P <0.001 respectively) and LA Vmax/BSA (u =0.54; P<0.001 and u =0.53; P<0.001 respectively). Among strain and SR indices, V1-NTF and TPD showed the best negative correlation with global PALS (r ={u2212}0.75, P <0.001 and r ={u2212}0.72, P <0.001 respectively). P wave dispersion correlated poorly with both volumetric and functional LA indices. Using receiver operating characteristic curve analysis, TPD {u2265}110 ms, V1-NTF {u2265}4 ms.mV and P notching predicted global PALS {u2264} 30% with a sensitivity of 90%, 95% and 50% and a specificity of 87.4%, 94.3% and 100% respectively. Global PALS was significantly lower in patients who had P notching compared to those without P notching (23.84 ± 5.92 versus 38.67 ± 9.4 %, P<0.001). Conclusion: P wave abnormalities including prolonged TPD, abnormal V1-NTF and P wave notching are strong predictors of abnormal LA function

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