title: P wave area for quantitative electrocardiographic assessment of left atrial remodeling.
abstract: BACKGROUND
  Left atrial (LA) dilation provides a substrate for mitral regurgitation (MR) and atrial arrhythmias. ECG can screen for LA dilation but standard approaches do not assess LA geometry as a continuum, as does non-invasive imaging. This study tested ECG-quantified P wave area as an index of LA geometry.
  
  
  RESULTS
  342 patients with CAD underwent ECG and CMR within 7 (0.1±1.4) days. LA area on CMR correlated best with P wave area in ECG lead V1 (r = 0.42, p<0.001), with lesser correlations for P wave amplitude and duration. P wave area increased stepwise in relation to CMR-evidenced MR severity (p<0.001), with similar results for MR on echocardiography (performed in 86% of patients). Pulmonary arterial (PA) pressure on echo was increased by 50% among patients in the highest (45±14 mmHg) vs. the lowest (31±9 mmHg) P wave area quartile of the population. In multivariate regression, CMR and echo-specific models demonstrated P wave area to be independently associated with LA size after controlling for MR, as well as echo-evidenced PA pressure. Clinical follow-up (mean 2.4±1.9 years) demonstrated ECG and CMR to yield similar results for stratification of arrhythmic risk, with a 2.6-fold increase in risk for atrial fibrillation/flutter among patients in the top P wave area quartile of the population (CI 1.1-5.9, p = 0.02), and a 3.2-fold increase among patients in the top LA area quartile (CI 1.4-7.0, p = 0.005).
  
  
  CONCLUSIONS
  ECG-quantified P wave area provides an index of LA remodeling that parallels CMR-evidenced LA chamber geometry, and provides similar predictive value for stratification of atrial arrhythmic risk.
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America; Department of Radiology, Weill Cornell Medical College, New York, New York, United States of America; Memorial Sloan Kettering Cancer Center Department of Medicine, New York, New York, United States of America.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Weinsaft
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America; Duke University School of Medicine, Durham, North Carolina, United States of America.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Kochav
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America; Memorial Sloan Kettering Cancer Center Department of Medicine, New York, New York, United States of America.
authors.forename: Jiwon
authors.initials: J
authors.lastname: Kim
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Sergey
authors.initials: S
authors.lastname: Gurevich
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Volo
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Anika
authors.initials: A
authors.lastname: Afroz
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Maya
authors.initials: M
authors.lastname: Petashnick
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Agnes
authors.initials: A
authors.lastname: Kim
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.affiliation: Greenberg Cardiology Division/Department of Medicine, Weill Cornell Medical College, New York, New York, United States of America.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000503:physiopathology; D064752:Atrial Remodeling; D001794:Blood Pressure; D003324:Coronary Artery Disease / Q000175:diagnosis; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000473:pathology; D012720:Severity of Illness Index