{"title":"P 波持续时间与 P 波矢量大小之比对急性前壁心肌梗死死亡率的预后意义","authors":"Masamichi Yano, Yasuyuki Egami, Masaru Abe, Mizuki Osuga, Hiroaki Nohara, Shodai Kawanami, Kohei Ukita, Akito Kawamura, Koji Yasumoto, Naotaka Okamoto, Yasuharu Matsunaga-Lee, Masami Nishino","doi":"10.1016/j.jelectrocard.2024.153791","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>The impact of P-wave abnormality in acute anterior MI, where the culprit vessel is the left anterior descending artery, remains undetermined. This study aimed to elucidate the impact of P-wave morphology on clinical outcomes in acute anterior MI.</p></div><div><h3>Methods</h3><p>Patients undergoing emergent percutaneous coronary intervention for acute anterior MI were enrolled between September 2014 and April 2019 (derivation cohort) and May 2019 through July 2023 (validation cohort). P-wave duration (Pd) and P-wave vector magnitude (Pvm) were measured. The Pvm was calculated as the square root of the sum of the squared P-wave magnitudes in leads II and V6 and one-half of the P-wave amplitude in V2. The patients were categorized into high and low Pd/Pvm groups using a statistically derived cut-off value. The endpoint comprised the composite of heart failure (HF) hospitalization and all-cause death.</p></div><div><h3>Results</h3><p>Consecutive 426 patients were enrolled in this study (derivation cohort, 213 patients; validation cohort, 216 patients). The calculated cut-off value of Pd/Pvm for predicting the clinical endpoint, determined through receiver operating curve analysis, was 793.5 ms/mV (area under the curve [AUC] = 0.85, sensitivity of 73.8 %, and specificity of 94.0 %) in the derivation cohort. Kaplan-Meier analyses revealed a significantly higher risk of the endpoint in patients with high Pd/Pvm than those with low Pd/Pvm in derivation and validation cohorts (Log-rank <em>p</em> < 0.001 and p < 0.001, respectively). Multivariate Cox proportional hazards analysis identified advanced age, elevated Pd/Pvm, and reduced left ventricular ejection fraction as independent and significant factors associated with the endpoint in the validation cohort (<em>p</em> = 0.008, <em>p</em> < 0.001, and p < 0.001, respectively).</p></div><div><h3>Conclusion</h3><p>High Pd/Pvm was significantly associated with the composite of HF hospitalization and all-cause death after acute anterior MI.</p></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"87 ","pages":"Article 153791"},"PeriodicalIF":1.3000,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prognostic significance of ratio of P-wave duration to P-wave vector magnitude for mortality in acute anterior myocardial infarction\",\"authors\":\"Masamichi Yano, Yasuyuki Egami, Masaru Abe, Mizuki Osuga, Hiroaki Nohara, Shodai Kawanami, Kohei Ukita, Akito Kawamura, Koji Yasumoto, Naotaka Okamoto, Yasuharu Matsunaga-Lee, Masami Nishino\",\"doi\":\"10.1016/j.jelectrocard.2024.153791\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>The impact of P-wave abnormality in acute anterior MI, where the culprit vessel is the left anterior descending artery, remains undetermined. This study aimed to elucidate the impact of P-wave morphology on clinical outcomes in acute anterior MI.</p></div><div><h3>Methods</h3><p>Patients undergoing emergent percutaneous coronary intervention for acute anterior MI were enrolled between September 2014 and April 2019 (derivation cohort) and May 2019 through July 2023 (validation cohort). P-wave duration (Pd) and P-wave vector magnitude (Pvm) were measured. The Pvm was calculated as the square root of the sum of the squared P-wave magnitudes in leads II and V6 and one-half of the P-wave amplitude in V2. The patients were categorized into high and low Pd/Pvm groups using a statistically derived cut-off value. The endpoint comprised the composite of heart failure (HF) hospitalization and all-cause death.</p></div><div><h3>Results</h3><p>Consecutive 426 patients were enrolled in this study (derivation cohort, 213 patients; validation cohort, 216 patients). The calculated cut-off value of Pd/Pvm for predicting the clinical endpoint, determined through receiver operating curve analysis, was 793.5 ms/mV (area under the curve [AUC] = 0.85, sensitivity of 73.8 %, and specificity of 94.0 %) in the derivation cohort. Kaplan-Meier analyses revealed a significantly higher risk of the endpoint in patients with high Pd/Pvm than those with low Pd/Pvm in derivation and validation cohorts (Log-rank <em>p</em> < 0.001 and p < 0.001, respectively). Multivariate Cox proportional hazards analysis identified advanced age, elevated Pd/Pvm, and reduced left ventricular ejection fraction as independent and significant factors associated with the endpoint in the validation cohort (<em>p</em> = 0.008, <em>p</em> < 0.001, and p < 0.001, respectively).</p></div><div><h3>Conclusion</h3><p>High Pd/Pvm was significantly associated with the composite of HF hospitalization and all-cause death after acute anterior MI.</p></div>\",\"PeriodicalId\":15606,\"journal\":{\"name\":\"Journal of electrocardiology\",\"volume\":\"87 \",\"pages\":\"Article 153791\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2024-09-02\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of electrocardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0022073624002619\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of electrocardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022073624002619","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景急性前壁心肌梗死的罪魁祸首是左前降支动脉，P波异常对该病的影响仍未确定。本研究旨在阐明 P 波形态对急性前壁心肌梗死临床预后的影响。方法在 2014 年 9 月至 2019 年 4 月（衍生队列）和 2019 年 5 月至 2023 年 7 月（验证队列）期间，对因急性前壁心肌梗死接受急诊经皮冠状动脉介入治疗的患者进行了登记。测量了P波持续时间（Pd）和P波矢量幅度（Pvm）。Pvm 的计算公式为 II 和 V6 导联 P 波幅度平方和的平方根，以及 V2 导联 P 波振幅的二分之一。根据统计得出的临界值将患者分为高 Pd/Pvm 组和低 Pd/Pvm 组。研究终点包括心力衰竭（HF）住院和全因死亡的综合结果。结果本研究共招募了 426 名患者（推导队列，213 名患者；验证队列，216 名患者）。在推导队列中，通过接收器操作曲线分析确定的预测临床终点的 Pd/Pvm 临界值为 793.5 ms/mV（曲线下面积 [AUC] = 0.85，灵敏度为 73.8%，特异度为 94.0%）。Kaplan-Meier 分析显示，在衍生队列和验证队列中，Pd/Pvm 高的患者出现终点的风险明显高于 Pd/Pvm 低的患者（Log-rank p < 0.001 和 p < 0.001）。多变量 Cox 比例危险分析发现，高龄、Pd/Pvm 升高和左室射血分数降低是验证队列中与终点相关的独立且显著的因素（分别为 p = 0.008、p < 0.001 和 p < 0.001）。
Prognostic significance of ratio of P-wave duration to P-wave vector magnitude for mortality in acute anterior myocardial infarction
Background
The impact of P-wave abnormality in acute anterior MI, where the culprit vessel is the left anterior descending artery, remains undetermined. This study aimed to elucidate the impact of P-wave morphology on clinical outcomes in acute anterior MI.
Methods
Patients undergoing emergent percutaneous coronary intervention for acute anterior MI were enrolled between September 2014 and April 2019 (derivation cohort) and May 2019 through July 2023 (validation cohort). P-wave duration (Pd) and P-wave vector magnitude (Pvm) were measured. The Pvm was calculated as the square root of the sum of the squared P-wave magnitudes in leads II and V6 and one-half of the P-wave amplitude in V2. The patients were categorized into high and low Pd/Pvm groups using a statistically derived cut-off value. The endpoint comprised the composite of heart failure (HF) hospitalization and all-cause death.
Results
Consecutive 426 patients were enrolled in this study (derivation cohort, 213 patients; validation cohort, 216 patients). The calculated cut-off value of Pd/Pvm for predicting the clinical endpoint, determined through receiver operating curve analysis, was 793.5 ms/mV (area under the curve [AUC] = 0.85, sensitivity of 73.8 %, and specificity of 94.0 %) in the derivation cohort. Kaplan-Meier analyses revealed a significantly higher risk of the endpoint in patients with high Pd/Pvm than those with low Pd/Pvm in derivation and validation cohorts (Log-rank p < 0.001 and p < 0.001, respectively). Multivariate Cox proportional hazards analysis identified advanced age, elevated Pd/Pvm, and reduced left ventricular ejection fraction as independent and significant factors associated with the endpoint in the validation cohort (p = 0.008, p < 0.001, and p < 0.001, respectively).
Conclusion
High Pd/Pvm was significantly associated with the composite of HF hospitalization and all-cause death after acute anterior MI.
期刊介绍：
The Journal of Electrocardiology is devoted exclusively to clinical and experimental studies of the electrical activities of the heart. It seeks to contribute significantly to the accuracy of diagnosis and prognosis and the effective treatment, prevention, or delay of heart disease. Editorial contents include electrocardiography, vectorcardiography, arrhythmias, membrane action potential, cardiac pacing, monitoring defibrillation, instrumentation, drug effects, and computer applications.
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