Back to Browse Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 8

P-wave indices in patients with pulmonary emphysema: do P-terminal force and interatrial block have confounding effects?

Authors Chhabra L, Chaubey VK, Kothagundla C, Bajaj R, Kaul S, Spodick DH

Published Date May 2013 Volume 2013:8 Pages 245—250

DOI http://dx.doi.org/10.2147/COPD.S45127

Received 12 March 2013, Accepted 12 April 2013, Published 14 May 2013

Lovely Chhabra,1 Vinod K Chaubey,1 Chandrasekhar Kothagundla,1 Rishi Bajaj,1 Sudesh Kaul,1 David H Spodick2

1Department of Internal Medicine, 2Department of Cardiovascular Diseases, University of Massachusetts Medical School, Worcester, MA, USA

Introduction: Pulmonary emphysema causes several electrocardiogram changes, and one of the most common and well known is on the frontal P-wave axis. P-axis verticalization (P-axis > 60°) serves as a quasidiagnostic indicator of emphysema. The correlation of P-axis verticalization with the radiological severity of emphysema and severity of chronic obstructive lung function have been previously investigated and well described in the literature. However, the correlation of P-axis verticalization in emphysema with other P-indices like P-terminal force in V1 (Ptf), amplitude of initial positive component of P-waves in V1 (i-PV1), and interatrial block (IAB) have not been well studied. Our current study was undertaken to investigate the effects of emphysema on these P-wave indices in correlation with the verticalization of the P-vector.
Materials and methods: Unselected, routinely recorded electrocardiograms of 170 hospitalized emphysema patients were studied. Significant Ptf (s-Ptf) was considered ≥40 mm.ms and was divided into two types based on the morphology of P-waves in V1: either a totally negative (-) P wave in V1 or a biphasic (+/-) P wave in V1.
Results: s-Ptf correlated better with vertical P-vectors than nonvertical P-vectors (P = 0.03). s-Ptf also significantly correlated with IAB (P = 0.001); however, IAB and P-vector verticalization did not appear to have any significant correlation (P = 0.23). There was a very weak correlation between i-PV1 and frontal P-vector (r = 0.15; P = 0.047); however, no significant correlation was found between i-PV1 and P-amplitude in lead III (r = 0.07; P = 0.36).
Conclusion: We conclude that increased P-tf in emphysema may be due to downward right atrial position caused by right atrial displacement, and thus the common assumption that increased P-tf implies left atrial enlargement should be made with caution in patients with emphysema. Also, the lack of strong correlation between i-PV1 and P-amplitude in lead III or vertical P-vector may suggest the predominant role of downward right atrial distortion rather than right atrial enlargement in causing vertical P-vector in emphysema.

Keywords: P-terminal force, interatrial block, emphysema, vertical P-vector, P-axis, left atrial enlargement

Download Article [PDF] View Full Text [HTML] 

Creative Commons License This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php

Other articles by this author:

Diagnostic electrocardiographic dyad criteria of emphysema in left ventricular hypertrophy

Lanjewar SS, Chhabra L, Chaubey VK, Joshi S, Kulkarni G, Kothagundla C, Kaul S, Spodick DH

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:591-594

Published Date: 22 November 2013

Optimal electrocardiographic limb lead set for rapid emphysema screening

Bajaj R, Chhabra L, Basheer Z, Spodick DH

International Journal of Chronic Obstructive Pulmonary Disease 2013, 8:41-44

Published Date: 19 January 2013

Readers of this article also read:

Incidence of bleb-associated endophthalmitis in the United States

Vaziri K, Kishor K, Schwartz SG, Maharaj AS, Moshfeghi DM, Moshfeghi AA, Flynn HW Jr

Clinical Ophthalmology 2015, 9:317-322

Published Date: 12 February 2015

Multifunction hexagonal liquid-crystal containing modified surface TiO2 nanoparticles and terpinen-4-ol for controlled release

Manaia EB, Kaminski RCK, Oliveira AG, Corrêa MA, Chiavacci LA

International Journal of Nanomedicine 2015, 10:811-819

Published Date: 22 January 2015

PEGylated apoptotic protein-loaded PLGA microspheres for cancer therapy

Byeon HJ, Kim I, Choi JS, Lee ES, Shin BS, Youn YS

International Journal of Nanomedicine 2015, 10:739-748

Published Date: 19 January 2015

Pediatric cataract: challenges and future directions

Medsinge A, Nischal KK

Clinical Ophthalmology 2015, 9:77-90

Published Date: 7 January 2015

Treating cutaneous squamous cell carcinoma using 5-aminolevulinic acid polylactic-co-glycolic acid nanoparticle-mediated photodynamic therapy in a mouse model

Wang X, Shi L, Tu Q, Wang H, Zhang H, Wang P, Zhang L, Huang Z, Zhao F, Luan H, Wang X

International Journal of Nanomedicine 2015, 10:347-355

Published Date: 6 January 2015

Involvement of NF-ΚB and HSP70 signaling pathways in the apoptosis of MDA-MB-231 cells induced by a prenylated xanthone compound, α-mangostin, from Cratoxylum arborescens

Ibrahim MY, Hashim NM, Mohan S, Abdulla MA, Abdelwahab SI, Kamalidehghan B, Ghaderian M, Dehghan F, Ali LZ, Karimian H, Yahayu M, Ee GCL, Farjam AS, Ali HM

Drug Design, Development and Therapy 2014, 8:2193-2211

Published Date: 6 November 2014