Relationship between abnormal P-wave terminal force in lead V1and left ventricular diastolic dysfunction in hypertensive patients: the LIFE study.
BACKGROUND
Abnormal P-wave terminal force in lead V1(PTF-V1) is an ECG marker of increased left atrial (LA) volume, elevated LA filling pressures and/or LA systolic dysfunction. Because left ventricular (LV) diastolic dysfunction is one of the potential mechanisms driving LA remodelling, we hypothesized that PTF-V1might be an additional ECG marker of diastolic dysfunction.


METHODS
LV diastolic function after 3 years' systematic antihypertensive treatment was examined in relation to baseline PTF-V1in 431 hypertensive patients undergoing protocol-driven blood pressure reduction who had baseline and year-3 ECG and echocardiographic data and a preserved LV ejection fraction (EF >45%) at year-3. Abnormal diastolic function was defined by the tenth or 90th percentile values from 405 normotensive, non-obese and non-diabetic adults without overt cardiovascular disease. Abnormal PTF-V1,defined by the presence of a negative terminal P-wave in lead V1 ≥ 4000 μV·ms, was present in 167 patients (38.7%).


RESULTS
Abnormal PTF-V1was associated with worse year-3 mean diastolic first third filling time (0.43 ± 0.08 vs 0.40 ± 0.07 sec, p = 0.039), first half filling time (0.55 ± 0.07 vs 0.53 ± 0.07 sec, p = 0.041), mitral valve A velocity (86 ± 27 vs 76 ± 19 cm/sec, p = 0.009) and mitral valve E/A ratio (0.85 ± 0.22 vs 0.94 ± 0.27, p = 0.007) after adjusting for other potential predictors of diastolic dysfunction including race, and heart rate, systolic blood pressure and severity of ECG LVH by Cornell product criteria at baseline. In parallel multivariate logistic regression analysis, abnormal PTF-V1was associated with significantly increased odds of abnormal mitral valve E/A ratio (OR 1.55, 95%CI 1.04-2.32 p = 0.032), and a trend toward higher odds of abnormal half filling time (OR 1.42, 95%CI 0.94-2.15, p = 0.098) at year-3 of follow-up.


CONCLUSIONS
Abnormal P-wave terminal force in lead V1is associated with worse diastolic function and predicts abnormal LV diastolic behaviour in patients with preserved EF after 3 years of blood pressure reductive therapy.
a Greenberg Division of Cardiology , Weill Cornell Medical College , New York , NY , USA.
Michael T
MT
Tanoue
b Ullevål Hospital, University of Oslo , Oslo , Norway.|c Department of Medicine, University of Michigan Medical Center , Ann Arbor , MI , USA.
Sverre E
SE
Kjeldsen
a Greenberg Division of Cardiology , Weill Cornell Medical College , New York , NY , USA.
Richard B
RB
Devereux
a Greenberg Division of Cardiology , Weill Cornell Medical College , New York , NY , USA.
Peter M
PM
Okin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064752:Atrial Remodeling; D001794:Blood Pressure; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
Diastole; heart failure; hypertension; hypertrophy