Research Article
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Usefulness of P Wave Dispersion in Predicting Coronary Artery Disease Severity

Year 2017, Volume: 20 Issue: 2, 111 - 115, 01.08.2017

Abstract

Introduction: Because
only a small proportion of patients undergoing coronary angiography have
obstructive coronary artery disease (CAD), further markers are necessary to
predict CAD severity. The aim of our study was to investigate the importance of
P wave dispersion for predicting obstructive CAD and its severity in patients
undergoing coronary angiography for positive myocardial perfusion scintigraphy.



Patients and Methods:
Overall,
126 patients who underwent coronary angiography for positive myocardial
perfusion scintigraphy were included in the study. The patients were divided
into three groups based on coronary angiography findings: group 1, patients
with non-obstructive CAD; group 2, patients with obstructive CAD in only one
vessel; and group 3, patients with obstructive CAD in more than one vessel. The
groups were compared for P wave duration and P wave dispersion. Gensini score
was used to evaluate CAD severity.



Results: There was
no significant difference among the groups regarding P wave duration at rest.
However, there was a significant difference among the groups regarding P wave
duration at recovery (117.10 ± 13.69 msn, 127.64 ± 12.70 msn, 130.51 ± 11.84
msn, respectively, p< 0.001). When the groups were compared for P wave
dispersion, we found a statistical significant difference among the groups
(13.63 ± 6.38 msn, 22.48 ± 3.98 msn, 27.14 ± 6.22 msn, respectively, p<
0.001). There was a positive correlation between P wave dispersion and Gensini
score (r= 0.390, p< 0.001).



Conclusion: Our findings suggested that
P wave dispersion increases the sensitivity and specificity of positive
myocardial perfusion scintigraphy for predicting obstructive CAD and its
severity.

References

  • 1. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34:2949-3003.
  • 2. Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med 2010;362:886-95.
  • 3. Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J1998;135:733.
  • 4. Yilmaz R, Demirbag R. P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. J Electrocardiol 2005;38:279-84.
  • 5. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606.
  • 6. Maganis JC, Gupta B, Gamie SH, LaBarbera JJ, Startt-Selvester RH, Ellestad MH. Usefulness of p-wave duration to identify myocardial ischemia during exercise testing. Am J Cardiol 2010;105:1365-70.
  • 7. Hesse B, Tagil K, Cuocolo A, Anagnostopoulos C, Bardies M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 2005;32:855-97.
  • 8. Elhendy A, van Domburg RT, Bax JJ, Poldermans D, Sozzi FB, Roelandt JR. Accuracy of dobutamine technetium 99 m sestamibi SPECT imaging for the diagnosis of single-vessel coronary artery disease: Comparison with echocardiography. Am Heart J 2000;139:224-30.
  • 9. Smart SC, Bhatia A, Hellman R, Stoiber T, Krasnow A, Collier BD, et al. Dobutamine-atropine stress echocardiography and dipyridamole sestamibi scintigraphy for the detection of coronary artery disease: Limitations and concordance. J Am CollCardiol 2000;36:1265-73.
  • 10. Bourque JM, Beller GA. Stress myocardial perfusion imaging for assessing prognosis: an update. JACC Cardiovasc Imaging 2011;4:1305-19.
  • 11. Verna E, Ceriani L, Giovanella L, Binaghi G, Garancini S. “False-positive” myocardial perfusion scintigraphy findings in patients with angiographically normal coronary arteries: insights from intravascular sonography studies. J Nucl Med 2000;41:1935-40.
  • 12. Aytemir K, Ozer N, Atalar E, Sade E, Aksöyek S, Ovünç K, et al. P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23:1109-12.
  • 13. Koyuncu I, Tuluce K, Tuluce SY, Koyuncu B, Eyuboglu M, Gursul E, et al. Diagnostic value of combining heart rate recovery and P-wave changes with exercise-induced changes in the ST segments for prediction of myocardial ischaemia. Acta Cardiol 2015;70:422-9.
  • 14. Dilaveris PE, Andrikopoulos GK, Metaxas G, Richter DJ, Avgeropoulou CK, Androulakis AM, et al. Effects of ischemia on P wave dispersion and maximum P wave duration during spontaneous anginal episodes. Pacing Clin Electrophysiol 1999;22:1640-7.

Koroner Arter Hastalığının Şiddetini Tahmin Etmek İçin P Dalga Dispersiyonunun Kullanılabilirliği

Year 2017, Volume: 20 Issue: 2, 111 - 115, 01.08.2017

Abstract

Giriş: Koroner anjiyografi uygulanan hastaların sadece küçük bir kısmında
tıkayıcı koroner arter hastalığı (KAH) saptandığı düşünüldüğünde, KAH
ciddiyetini öngörebilecek yeni belirteçlerin saptanması önem taşımaktadır.
Çalışmamızın amacı, stabil KAH ile başvuran ve miyokart perfüzyon
sintigrafisinde iskemi saptanması nedeniyle 
koroner anjiyografi uygulanan hastalarda tıkayıcı KAH varlığı ve KAH
yaygınlığını öngörmede P dalga dispersiyonun önemini test etmektir



Hastalar ve
Yöntem:
Miyokart perfüzyon sintigrafisinde  iskemi saptanması nedeniyle koroner
anjiyografi uygulanan 126 hasta çalışmaya dahil edildi. Anjiyografi sonucuna
göre hastalar tıkayıcı KAH saptanmayan (grup 1), tek damarda tıkayıcı KAH
saptanan (grup 2) ve birden fazla damarda tıkayıcı KAH saptanan hastalar (grup
3 ) olmak üzere üç gruba ayrıldı. Gruplar P dalga süreleri ve P dalga
dispersiyonu açısından birbirleriyle karşılaştırıldı. KAH yaygınlığını
değerlendirmek için Gensini skoru kullanıldı.



Bulgular: İstirahat P dalga süreleri açısından gruplar birbiriyle
karşılaştırıldığında, üç grup arasında istatistiksel olarak anlamlı fark
saptanmazken, P dalga recovery süreleri açısından gruplar birbiriyle
karşılaştırıldığında ise, üç grup arasında istatistiksel olarak anlamlı fark
saptandı (sırasıyla 117.10 ± 13.69 msn, 127.64 ± 12.70 msn, 130.51 ± 11.84 msn,
p< 0.001). P dalga dispersiyonu açısından gruplar birbiriyle
karşılaştırıldığında, her üç grup arasında da istatistiksel olarak anlamlı fark
saptandı (sırasıyla 13.63 ± 6.38 msn, 22.48 ± 3.98 msn, 27.14 ± 6.22 msn, p<
0.001). P dalga süre değişikliği ve Gensini skoru arasında  pozitif yönde korelasyon izlendi. P dalga
süre değişikliği arttıkça Gensini skorunun da arttığı tespit edildi ( r= 0.390,
p< 0.001).



Sonuç: Çalışmamızın sonuçları
miyokart perfüzyon sintigrafisi sonucuna P dalga dispersiyonunun eklenmesinin
tıkayıcı KAH ve KAH yaygınlığını belirlemede testin duyarlılığını ve
özgüllüğünü anlamlı olarak artırdığını göstermektedir.

References

  • 1. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34:2949-3003.
  • 2. Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med 2010;362:886-95.
  • 3. Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, et al. Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J1998;135:733.
  • 4. Yilmaz R, Demirbag R. P-wave dispersion in patients with stable coronary artery disease and its relationship with severity of the disease. J Electrocardiol 2005;38:279-84.
  • 5. Gensini GG. A more meaningful scoring system for determining the severity of coronary heart disease. Am J Cardiol 1983;51:606.
  • 6. Maganis JC, Gupta B, Gamie SH, LaBarbera JJ, Startt-Selvester RH, Ellestad MH. Usefulness of p-wave duration to identify myocardial ischemia during exercise testing. Am J Cardiol 2010;105:1365-70.
  • 7. Hesse B, Tagil K, Cuocolo A, Anagnostopoulos C, Bardies M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 2005;32:855-97.
  • 8. Elhendy A, van Domburg RT, Bax JJ, Poldermans D, Sozzi FB, Roelandt JR. Accuracy of dobutamine technetium 99 m sestamibi SPECT imaging for the diagnosis of single-vessel coronary artery disease: Comparison with echocardiography. Am Heart J 2000;139:224-30.
  • 9. Smart SC, Bhatia A, Hellman R, Stoiber T, Krasnow A, Collier BD, et al. Dobutamine-atropine stress echocardiography and dipyridamole sestamibi scintigraphy for the detection of coronary artery disease: Limitations and concordance. J Am CollCardiol 2000;36:1265-73.
  • 10. Bourque JM, Beller GA. Stress myocardial perfusion imaging for assessing prognosis: an update. JACC Cardiovasc Imaging 2011;4:1305-19.
  • 11. Verna E, Ceriani L, Giovanella L, Binaghi G, Garancini S. “False-positive” myocardial perfusion scintigraphy findings in patients with angiographically normal coronary arteries: insights from intravascular sonography studies. J Nucl Med 2000;41:1935-40.
  • 12. Aytemir K, Ozer N, Atalar E, Sade E, Aksöyek S, Ovünç K, et al. P wave dispersion on 12-lead electrocardiography in patients with paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2000;23:1109-12.
  • 13. Koyuncu I, Tuluce K, Tuluce SY, Koyuncu B, Eyuboglu M, Gursul E, et al. Diagnostic value of combining heart rate recovery and P-wave changes with exercise-induced changes in the ST segments for prediction of myocardial ischaemia. Acta Cardiol 2015;70:422-9.
  • 14. Dilaveris PE, Andrikopoulos GK, Metaxas G, Richter DJ, Avgeropoulou CK, Androulakis AM, et al. Effects of ischemia on P wave dispersion and maximum P wave duration during spontaneous anginal episodes. Pacing Clin Electrophysiol 1999;22:1640-7.
There are 14 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Original Investigations
Authors

Hande Kangül This is me

Mehmet Eyüboğlu

Ömer Kozan This is me

Publication Date August 1, 2017
Published in Issue Year 2017 Volume: 20 Issue: 2

Cite

Vancouver Kangül H, Eyüboğlu M, Kozan Ö. Koroner Arter Hastalığının Şiddetini Tahmin Etmek İçin P Dalga Dispersiyonunun Kullanılabilirliği. Koşuyolu Heart Journal. 2017;20(2):111-5.