Electromechanical Demonstration of Premature Ventricular Contraction-Induced Atrial Cardiomyopathy by P Wave Duration-to-Amplitude Ratio (PWDAR) and Left Atrial Strain

Abstract

Introduction: High premature ventricular contraction (PVC) burden is known to cause atrial remodeling. P wave duration-to-amplitude ratio (PWDAR) is a new P wave index that includes both P wave duration and P wave voltage, which can be considered to effectively evaluate atrial cardiomyopathy. 3D speckle-tracking echocardiography is accepted as a valid and reliable technique for assessment of the left ventricle (LV) and left atrium (LA). Aim: In the present study, we investigated whether patients with a high PVC burden exhibit subclinical left atrial electrical and mechanical dysfunction, assessed electrically using PWDAR and mechanically using 3D-speckle tracking echocardiography. Material and methods: Seventy-five patients with PVC (PVC+) and 75 age- and gender-matched controls were enrolled in the study. Surface 12-lead standard electrocardiograms (ECGs) were recorded. Clinical characteristics and laboratory values of the patients were obtained. Conventional 2D echocardiographic and 3D-STE analyses were performed. Results: The PWDAR was significantly higher in the PVC+ group than in the control group (p < 0.001); and the LAS-r, LAS-active, and LV-GLS were significantly depressed in the PVC+ group (p < 0.001, p < 0.001, p = 0.015, respectively). The multivariate regression models demonstrated that PWDAR (p < 0.001), LAS-r (p < 0.001), LAS-active (p = 0.008), and LV-GLS (p = 0.021) were independent factors predicting PVC-induced atrial cardiomyopathy (PVC-ACMP). Conclusions: Our results revealed subclinical left atrial electrical and mechanical dysfunction in patients with a high PVC burden. PWDAR and left atrial strain parameters can predict PVC-ACMP.