Electrocardiographic evidence of atrial cardiomyopathy in mitral stenosis: a retrospective analysis in a Chinese cohort

• Published in: Journal of electrocardiology 2018-11, Vol.51 (6), p.1169-1169
• Main Authors: Wong, Ricko, Wong, Pui, Zhang, Enpei, Chan, Calista Zhuo Yi, Li, Guangping, Wong, Wing Tak, Chan, Yat Sun, Wong, Martin, Liu, Tong, Baranchuk, Adrian, Lip, Gregory, Lee, Alex, Tse, Gary
• Format: Article
• Language: English
• Subjects: Cardiomyopathy; Demographics; Electrocardiography; Patients
• ISSN: 0022-0736; 1532-8430
• DOI: 10.1016/j.jelectrocard.2018.10.030

Introduction: Mitral stenosis is associated with an atrial cardiomyopathy process involving both structural and electrical remodeling. This can lead to abnormal atrial electrophysiology, manifesting as prolonged P-wave durations (PWD), increased P-wave dispersion (PWDmax - PWDmin), and/or higher P-wave terminal force on lead VI (PTFV1) on the electrocardiogram (ECG). Methods: Electrocardiographic details of a cohort of Chinese patients with at least moderate mitral stenosis referred to our center between November 2009 and October 2016 for echocardiography were analyzed retrospectively and compared to controls without mitral stenosis. PWD > 120 ms in the absence and presence of biphasic P-waves in the inferior leads were termed partial and advanced interatrial block (IAB), respectively. Results: Compared to the age- and gender-matched control group (n = 79), patients with MS free from AF (n = 64) had longer P-wave duration (PWD) (127.4 ± 1.7 ms vs. 100.1 ± 1.81; ANOVA, P < 0.001), higher P-wave dispersion (37.5 ± 2.4 ms vs. 26.3 ± 2.1 ms; P < 0.01) and PTFV1 (107.3 ± 7.9 mm.mV vs. 2.1 ± 0.4 mm.mV; P < 0.001). Compared to those without IAB, those with IAB had similar P-wave dispersion (28.8 ± 5.7 ms vs. 26.9 ± 2.3 ms; P > 0.05) but significantly higher PTFV1: 116.6 ± 8.8 mm.mV vs. 72.8 ± 15.1 mm.mV; P < 0.05). Those with advanced inter-atrial block (n = 6) have PWD (137.8 ± 6.6 ms), P-wave dispersion (27.2 ± 7.5 ms) and PTFV1 (105.8 ± 28.2 mm.mV), which were statistically indistinguishable from those observed in patients with partial interatrial block (131.2 ± 1.5 ms, 26.8 ± 2.3 ms and 118.1 ± 9.0 mm.mV, respectively). Conclusion: IAB is a frequent electrophysiological abnormality in mitral stenosis. Mitral stenosis patients have longer PWD, higher P-wave dispersion and PTFV1 values than control subjects.