Usefulness of electrocardiographic parameters as compared with computed tomography measures of left atrial volume enlargement

From the ROMICAT trial

Quynh A. Truong, Elizabeth M. Charipar, Leon M. Ptaszek, Carolyn Taylor, Joao Daniel T. Fontes, Matthias Kriegel, Thomas Irlbeck, Amir A. Mahabadi, Ron Blankstein, Udo Hoffmann

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction: The 12-lead surface electrocardiogram (ECG) is commonly used as a noninvasive modality to assess for left atrial enlargement (LAE), but data comparing ECG against cardiac computed tomography (CT) for LAE is lacking. We aimed to determine the diagnostic performance of 6 ECG criteria for LAE as compared with CT left atrial volume (LAV) and index to body surface area (LAVI) as the reference standard. Materials and Methods: In 339 patients (age: mean ± mean, 53 ± 12 years; 63% male), we evaluated the quantitative ECG parameters of P duration, P to PR segment ratio, P wave area, and P terminal force in lead V1. We also assessed qualitatively the morphology of bifid and biphasic P waves. Patients were stratified into top and lowest quartile of LAV and LAVI by CT. Results: Of the 6 ECG criteria, patients with P duration greater than 110 milliseconds had a 21/2-fold increase likelihood of being in the top quartile of LAV (adjusted odds ratio [OR], 2.51; P = .01) and LAVI (adjusted OR, 2.74; P = .007) as measured by CT. For this ECG criterion, the sensitivity and specificity were 71% and 55% for CT LAE by LAV and 61% and 55% for LAVI. The remaining ECG parameters of LAE assessed (P to PR segment ratio, P terminal force in lead V1, P wave area, bifid, and biphasic P wave) were not associated with LAE by CT-based LAV or LAVI (all P ≥ .20). Discussion: Only P duration greater than 110 milliseconds was independently associated with LAE based on CT-derived LA volume and index. However, none of the established ECG parameters of LAE have sufficient diagnostic accuracies for predicting volumetric enlargement by CT, thus limiting its clinical utility.

Original languageEnglish (US)
Pages (from-to)257-264
Number of pages8
JournalJournal of Electrocardiology
Volume44
Issue number2
DOIs
StatePublished - Mar 2011
Externally publishedYes

Fingerprint

Electrocardiography
Tomography
Cone-Beam Computed Tomography
Odds Ratio
Body Surface Area
Sensitivity and Specificity
Lead

Keywords

  • Computed tomography
  • Electrocardiogram
  • Left atrial enlargement
  • Left atrial volume
  • Left atrium

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Usefulness of electrocardiographic parameters as compared with computed tomography measures of left atrial volume enlargement : From the ROMICAT trial. / Truong, Quynh A.; Charipar, Elizabeth M.; Ptaszek, Leon M.; Taylor, Carolyn; Fontes, Joao Daniel T.; Kriegel, Matthias; Irlbeck, Thomas; Mahabadi, Amir A.; Blankstein, Ron; Hoffmann, Udo.

In: Journal of Electrocardiology, Vol. 44, No. 2, 03.2011, p. 257-264.

Research output: Contribution to journalArticle

Truong, Quynh A. ; Charipar, Elizabeth M. ; Ptaszek, Leon M. ; Taylor, Carolyn ; Fontes, Joao Daniel T. ; Kriegel, Matthias ; Irlbeck, Thomas ; Mahabadi, Amir A. ; Blankstein, Ron ; Hoffmann, Udo. / Usefulness of electrocardiographic parameters as compared with computed tomography measures of left atrial volume enlargement : From the ROMICAT trial. In: Journal of Electrocardiology. 2011 ; Vol. 44, No. 2. pp. 257-264.
@article{89f4eddaeb4c4d64a07da820c8b98138,
title = "Usefulness of electrocardiographic parameters as compared with computed tomography measures of left atrial volume enlargement: From the ROMICAT trial",
abstract = "Introduction: The 12-lead surface electrocardiogram (ECG) is commonly used as a noninvasive modality to assess for left atrial enlargement (LAE), but data comparing ECG against cardiac computed tomography (CT) for LAE is lacking. We aimed to determine the diagnostic performance of 6 ECG criteria for LAE as compared with CT left atrial volume (LAV) and index to body surface area (LAVI) as the reference standard. Materials and Methods: In 339 patients (age: mean ± mean, 53 ± 12 years; 63{\%} male), we evaluated the quantitative ECG parameters of P duration, P to PR segment ratio, P wave area, and P terminal force in lead V1. We also assessed qualitatively the morphology of bifid and biphasic P waves. Patients were stratified into top and lowest quartile of LAV and LAVI by CT. Results: Of the 6 ECG criteria, patients with P duration greater than 110 milliseconds had a 21/2-fold increase likelihood of being in the top quartile of LAV (adjusted odds ratio [OR], 2.51; P = .01) and LAVI (adjusted OR, 2.74; P = .007) as measured by CT. For this ECG criterion, the sensitivity and specificity were 71{\%} and 55{\%} for CT LAE by LAV and 61{\%} and 55{\%} for LAVI. The remaining ECG parameters of LAE assessed (P to PR segment ratio, P terminal force in lead V1, P wave area, bifid, and biphasic P wave) were not associated with LAE by CT-based LAV or LAVI (all P ≥ .20). Discussion: Only P duration greater than 110 milliseconds was independently associated with LAE based on CT-derived LA volume and index. However, none of the established ECG parameters of LAE have sufficient diagnostic accuracies for predicting volumetric enlargement by CT, thus limiting its clinical utility.",
keywords = "Computed tomography, Electrocardiogram, Left atrial enlargement, Left atrial volume, Left atrium",
author = "Truong, {Quynh A.} and Charipar, {Elizabeth M.} and Ptaszek, {Leon M.} and Carolyn Taylor and Fontes, {Joao Daniel T.} and Matthias Kriegel and Thomas Irlbeck and Mahabadi, {Amir A.} and Ron Blankstein and Udo Hoffmann",
year = "2011",
month = "3",
doi = "10.1016/j.jelectrocard.2010.04.011",
language = "English (US)",
volume = "44",
pages = "257--264",
journal = "Journal of Electrocardiology",
issn = "0022-0736",
publisher = "Churchill Livingstone",
number = "2",

}

TY - JOUR

T1 - Usefulness of electrocardiographic parameters as compared with computed tomography measures of left atrial volume enlargement

T2 - From the ROMICAT trial

AU - Truong, Quynh A.

AU - Charipar, Elizabeth M.

AU - Ptaszek, Leon M.

AU - Taylor, Carolyn

AU - Fontes, Joao Daniel T.

AU - Kriegel, Matthias

AU - Irlbeck, Thomas

AU - Mahabadi, Amir A.

AU - Blankstein, Ron

AU - Hoffmann, Udo

PY - 2011/3

Y1 - 2011/3

N2 - Introduction: The 12-lead surface electrocardiogram (ECG) is commonly used as a noninvasive modality to assess for left atrial enlargement (LAE), but data comparing ECG against cardiac computed tomography (CT) for LAE is lacking. We aimed to determine the diagnostic performance of 6 ECG criteria for LAE as compared with CT left atrial volume (LAV) and index to body surface area (LAVI) as the reference standard. Materials and Methods: In 339 patients (age: mean ± mean, 53 ± 12 years; 63% male), we evaluated the quantitative ECG parameters of P duration, P to PR segment ratio, P wave area, and P terminal force in lead V1. We also assessed qualitatively the morphology of bifid and biphasic P waves. Patients were stratified into top and lowest quartile of LAV and LAVI by CT. Results: Of the 6 ECG criteria, patients with P duration greater than 110 milliseconds had a 21/2-fold increase likelihood of being in the top quartile of LAV (adjusted odds ratio [OR], 2.51; P = .01) and LAVI (adjusted OR, 2.74; P = .007) as measured by CT. For this ECG criterion, the sensitivity and specificity were 71% and 55% for CT LAE by LAV and 61% and 55% for LAVI. The remaining ECG parameters of LAE assessed (P to PR segment ratio, P terminal force in lead V1, P wave area, bifid, and biphasic P wave) were not associated with LAE by CT-based LAV or LAVI (all P ≥ .20). Discussion: Only P duration greater than 110 milliseconds was independently associated with LAE based on CT-derived LA volume and index. However, none of the established ECG parameters of LAE have sufficient diagnostic accuracies for predicting volumetric enlargement by CT, thus limiting its clinical utility.

AB - Introduction: The 12-lead surface electrocardiogram (ECG) is commonly used as a noninvasive modality to assess for left atrial enlargement (LAE), but data comparing ECG against cardiac computed tomography (CT) for LAE is lacking. We aimed to determine the diagnostic performance of 6 ECG criteria for LAE as compared with CT left atrial volume (LAV) and index to body surface area (LAVI) as the reference standard. Materials and Methods: In 339 patients (age: mean ± mean, 53 ± 12 years; 63% male), we evaluated the quantitative ECG parameters of P duration, P to PR segment ratio, P wave area, and P terminal force in lead V1. We also assessed qualitatively the morphology of bifid and biphasic P waves. Patients were stratified into top and lowest quartile of LAV and LAVI by CT. Results: Of the 6 ECG criteria, patients with P duration greater than 110 milliseconds had a 21/2-fold increase likelihood of being in the top quartile of LAV (adjusted odds ratio [OR], 2.51; P = .01) and LAVI (adjusted OR, 2.74; P = .007) as measured by CT. For this ECG criterion, the sensitivity and specificity were 71% and 55% for CT LAE by LAV and 61% and 55% for LAVI. The remaining ECG parameters of LAE assessed (P to PR segment ratio, P terminal force in lead V1, P wave area, bifid, and biphasic P wave) were not associated with LAE by CT-based LAV or LAVI (all P ≥ .20). Discussion: Only P duration greater than 110 milliseconds was independently associated with LAE based on CT-derived LA volume and index. However, none of the established ECG parameters of LAE have sufficient diagnostic accuracies for predicting volumetric enlargement by CT, thus limiting its clinical utility.

KW - Computed tomography

KW - Electrocardiogram

KW - Left atrial enlargement

KW - Left atrial volume

KW - Left atrium

UR - http://www.scopus.com/inward/record.url?scp=79952042419&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79952042419&partnerID=8YFLogxK

U2 - 10.1016/j.jelectrocard.2010.04.011

DO - 10.1016/j.jelectrocard.2010.04.011

M3 - Article

VL - 44

SP - 257

EP - 264

JO - Journal of Electrocardiology

JF - Journal of Electrocardiology

SN - 0022-0736

IS - 2

ER -