Document Detail

Usefulness of p-wave duration to identify myocardial ischemia during exercise testing.
MedLine Citation:
PMID:  20451680     Owner:  NLM     Status:  MEDLINE    
It is well recognized that ST-segment depression is due to subendocardial ischemia secondary to an increase in left ventricular end-diastolic pressure. The increase in left ventricular end-diastolic pressure is associated with increased left atrial pressure, resulting in left atrial wall distension that contributes to increasing P-wave duration (PWD). The objective of this study was to determine if PWD measured in leads II and V(5) during maximum exercise stress testing could be a reliable predictor of myocardial ischemia. Patients with suspected coronary disease underwent maximum exercise stress testing with myocardial perfusion imaging. PWD was measured using leads II and V(5) at rest and after exercise, with electrocardiographic complexes magnified 4 times (100 mm/s, 40 mm/mV). The change in PWD was calculated as Delta = PWD(recovery) - PWD(rest). DeltaPWD and ST-segment changes were related to the absence or presence of ischemia (localized reversible perfusion abnormalities) on myocardial perfusion imaging scans. DeltaPWD had sensitivity of 72%, specificity of 82%, negative predictive power (NPP) of 90%, and positive predictive power of 57%. ST-segment change had sensitivity of 34%, specificity of 87%, NPP of 80%, and positive predictive power of 47%. When DeltaPWD and ST changes were combined, sensitivity increased to 79% and NPP increased to 91%. In conclusion, DeltaPWD outperformed ST-segment changes in predicting myocardial ischemia on myocardial perfusion imaging scans. Furthermore, when DeltaPWD and ST-segment changes were combined, sensitivity and NPP were also significantly increased. In this study population, measuring DeltaPWD substantially increased the diagnostic value of maximum exercise stress testing.
Jonathan C Maganis; Bikash Gupta; Sherief H Gamie; Judith J LaBarbera; Ronald H Startt-Selvester; Myrvin H Ellestad
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-04-02
Journal Detail:
Title:  The American journal of cardiology     Volume:  105     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-10     Completed Date:  2010-06-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1365-70     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Inc. All rights reserved.
Memorial Heart and Vascular Institute, Long Beach Memorial Medical Center, Long Beach, California, USA.
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MeSH Terms
Cohort Studies
Exercise Test*
Heart Rate / physiology
Middle Aged
Myocardial Ischemia / diagnosis*
Myocardial Perfusion Imaging / methods
Physical Exertion / physiology
Recovery of Function
Retrospective Studies
Sensitivity and Specificity
Stroke Volume / physiology*
Time Factors
Tomography, Emission-Computed, Single-Photon

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