Logo: to the web site of Uppsala University

uu.sePublications from Uppsala University
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
A short P-wave duration is associated with incident heart failure in the elderly: a 15 years follow-up cohort study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.ORCID iD: 0000-0003-3493-041x
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.ORCID iD: 0000-0003-2335-8542
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology-Arrhythmia. Örebro Univ, Sch Med Sci, Fac Med & Hlth, Örebro, Sweden..ORCID iD: 0000-0003-2806-3903
2022 (English)In: Journal of Geriatric Cardiology, ISSN 1671-5411, Vol. 19, no 9, p. 643-650Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Early identification of patients at risk of congestive heart failure (HF) may alter their poor prognosis. The aim was therefore to test whether simple electrocardiographic variables, the P-wave and PR-interval, could predict incident HF.

METHODS: The PIVUS (Prospective Investigation of the Vasculature in Uppsala Seniors) study (1016 individuals all aged 70 years, 50% women) was used to identify predictors of HF. Subjects with prevalent HF, QRS duration z >= 130 ms, atrial tachyarrhythmias, implanted pacemaker/defibrillator, second- and third-degree atrioventricular block or delta waves at baseline were excluded. Cox proportional hazard analysis was used to relate the PR interval, P-wave duration (Pdur) and amplitude (Pamp), measured in lead V1, to incident HF. Adjustment was performed for gender, RR-interval, beta-blocking agents, systolic blood pressure, body mass index and smoking.

RESULTS: Out of 836 subjects at risk, 107 subjects were diagnosed with HF during a follow-up of 15 years. In the multivariate analysis, there was a strong U-shaped correlation between Pdur in lead V1 and incident HF (P= 0.0001) which was significant for a Pdur < 60 ms [HR = 2.75; 95% CI: 1.87-4.06, at Pdur 40 ms] but not for prolonged Pdur. There was no significant relationship between incident HF and the PR-interval or the Pamp. A Pdur < 60 ms improved discrimination by 3.7% when added to the traditional risk factors including sex, RR-interval, beta-blocking agents, systolic blood pressure, BMI and smoking (P= 0.048).

CONCLUSIONS: A short Pdur, an easily measured parameter on the ECG, may potentially be a useful marker of future HF, enabling its early detection and prevention, thus improving outcomes.

Place, publisher, year, edition, pages
Science Press, 2022. Vol. 19, no 9, p. 643-650
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-490898DOI: 10.11909/j.issn.1671-5411.2022.09.008ISI: 000890664500002PubMedID: 36284675OAI: oai:DiVA.org:uu-490898DiVA, id: diva2:1720307
Available from: 2022-12-19 Created: 2022-12-19 Last updated: 2024-01-09Bibliographically approved
In thesis
1. Risk factors for incident heart failure and atrial fibrillation in an elderly population: The role of cardiac conduction and heart rate variability
Open this publication in new window or tab >>Risk factors for incident heart failure and atrial fibrillation in an elderly population: The role of cardiac conduction and heart rate variability
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Heart failure (HF) and atrial fibrillation (AF) are epidemic diseases, frequently coexisting, sharing risk factors and conferring poor prognosis. Identification of individuals at high risk of HF and AF may enable early treatment and improve the prognosis. Reliable prediction models for daily clinical practice are lacking. Early modification and treatment of risk factors may reduce the incidence of AF and HF. Because atrial structure and function abnormalities increase the risk of AF, ECG indices reflecting atrial pathology may prove useful in predicting AF and HF.

The main objectives were to evaluate whether:

  • P-wave duration (Pdur) and PR-interval in V1 predicted incident HF and incident AF (Paper I-II)
  • low frequency/high frequency (L-F/H-F) ratio, a marker of autonomic balance, predicted incident HF (Paper IV)
  • combining selected ECG variables or the L-F/H-F ratio with traditional risk factors improved the performance of the traditional HF prediction model (Paper III-IV).

The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) with 15 years of follow-up was used for all four studies. After applying the exclusion criteria, 836 subjects were evaluated for incident HF (Paper I, III-IV) and 877 subjects for incident AF (Paper II). Cox proportional hazard analysis related ECG-derived variables to incident HF and incident AF. Study III used machine learning to determine which ECG variables correlated to incident HF. C-statistic was used to test whether adding selected ECG variables to traditional HF risk factors improved the performance of the HF prediction model.

Short Pdur was significantly associated with incident HF (Paper I) and incident AF (Paper II). Of 134 ECG variables, high R-wave amplitude variation (SD Ramp) had the highest predictive value for HF (Paper III). A decreased L-F/H-F ratio significantly predicted HF (Paper IV). Adding eight selected ECG variables (Paper III) and the L-F/H-F ratio (Paper IV) to the traditional risk factors significantly improved HF predictive performance by 11.7% and 3.3%, respectively.

In conclusion, the ECG may prove useful for predicting incident HF and AF beyond the traditional risk factors. An autonomic imbalance may precede the development of HF.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2024. p. 57
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 2007
Keywords
incident heart failure, incident atrial fibrillation, prediction of heart failure, short P-wave duration, heart rate variability.
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:uu:diva-518489 (URN)978-91-513-2002-1 (ISBN)
Public defence
2024-03-19, Enghoffsalen, Ing 50, Akademiska Sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2024-02-13 Created: 2023-12-19 Last updated: 2024-03-18

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMed

Authority records

Ostrowska, BozenaLind, LarsSciaraffia, ElenaBlomström-Lundqvist, Carina

Search in DiVA

By author/editor
Ostrowska, BozenaLind, LarsSciaraffia, ElenaBlomström-Lundqvist, Carina
By organisation
Cardiology-ArrhythmiaClinical Epidemiology
In the same journal
Journal of Geriatric Cardiology
Cardiac and Cardiovascular Systems

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 36 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf