Prolonged signal-averaged P wave duration as a prognostic marker for morbidity and mortality in patients with congestive heart failure.
OBJECTIVE
To evaluate the prognostic roles of prolonged signal-averaged P wave duration (SAPWD), raised levels of natriuretic peptides, and clinical characteristics in patients with stable congestive heart failure (CHF).


METHODS
The SAPWD was assessed from a signal-averaged electrocardiogram (SAECG), and the plasma levels of N-terminal pro-atrial natriuretic peptide (Nt-proANP) and N-terminal pro-brain natriuretic peptide (Nt-proBNP) were measured in 43 consecutive patients with stable CHF without prior supraventricular arrhythmia. Echocardiographic and clinical data were also recorded. Time to death, hospitalization due to deteriorated CHF, or ECG-documented atrial fibrillation (AF) was recorded over a 438-day median follow-up.


RESULTS
During follow-up, 17 patients met an endpoint defined as death, AF, or hospitalization due to deteriorated CHF. Proportional hazard regression including the variables high age, prolonged SAPWD, raised levels of Nt-proANP and Nt-proBNP, and low ejection fraction (EF) showed that only prolonged SAPWD > or =149 ms was associated with an increased risk of meeting an early endpoint; the hazard ratio 3.94 with 95% confidence interval 1.50-10.42; p = 0.006.


CONCLUSIONS
Prolonged SAPWD appears to predict early death, AF development, or hospitalization due to deterioration of CHF in patients with stable CHF.
Dixen
Ulrik
U
Department of Cardiology, University Hospital of Hvidore, Denmark. ulrikdixen@mail.dk
Wallevik
Laura
L
Hansen
Maja S
MS
Haghfelt
Anne
A
Aqraou
Katja F
KF
Abildstrom
Steen Z
SZ
Frandsen
Erik
E
Jensen
Gorm B
GB
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004077:Digoxin / Q000627:therapeutic use; D015716:Electrocardiography, Ambulatory; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D020097:Natriuretic Peptide, Brain; D009419:Nerve Tissue Proteins / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D015415:Biomarkers; D002121:Calcium Channel Blockers; D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D004077:Digoxin; D009320:Atrial Natriuretic Factor