P-Wave Configuration as an Indicator of Echocardiographic Indices of Cardiac Structure and Function in Normotensive Adolescents: Results (Part 2)

In: Cardiac Structure and Function

13 Oct 2012

As shown in Table 2, subjects with a normal, yet bimodal, P-wave in lead V, had higher two-hour averaged systolic BP (108 ± 12 mm Hg vs 99 ±7 mm Hg, p<0.01, respectively) and conventional sphygmomanometer systolic BP (110 ±11 mm Hg vs 103 ±10 mm Hg, p = 0.05, respectively). Compared with the unimodal P-wave group, the bimodal P-wave group had greater LV mass (174 ±40 g vs 144 ±26 g, p<0.01), LV mass index (110 ± 18 g/sq m vs 98 ± 16 g/ sq m, p<0.03), and stroke volume (68 ±15 ml vs 57 ± 13 ml, p<0.05, respectively).
Left atrial dimension was similar in both P-wave groups. Figure 1 displays the relationship of left atrial dimension to LV mass in all 40 subjects (r = 0.56, p<0.0001). In the bimodal P-wave group, this relationship was also significant (r = 0.60, p<0.003). By stepwise multiple linear regression, this correlation coefficient increased to 0.74 with the inclusion of heart rate and to 0.82 with inclusion of casual systolic BP. Body weight did not contribute further to the relationship described by the regression equation and was not included in the model. In the unimodal P-wave group, LA dimension also tended to increase with LV mass (r = 0.47, p = 0.051). Left atrial dimension was unrelated to any other parameter in the unimodal P-wave group.
Left atrial enlargement, left atrial abnormality,20 and altered LV filling are manifestations of cardiac end-organ involvement in patients with hypertension. P-wave abnormalities have been related to left atrial enlargement in hypertensive patients but may also be observed in the absence of left atrial enlargement, presumably reflecting intra-atrial conduction delay or other cardiac alterations. The young subjects in our study were not hypertensive and did not have left atrial enlargement or LV hypertrophy. buy levaquin online

Table 2—Cardiac Structural and Functional Characteristics by P-Wave Group

Bimodal P Wave (n = 22)


Unimodal P Wave (n = 18)

MSBP, mm Hg

108 ±12



MDBP, mm Hg

64 ± 6



CSBP, mm Hg

110± 11

= 0.05

103 ±10

CDBP, mm Hg



67 ±8

LV mass, g

174 ±40


144 ±26

LVMI, g/sq m

110 ± 18


98± 16

LA size, cm




SV, ml

68± 15


57 ±13

Figure 1. The relationship of left atrial dimension to left ventricular mass is depicted. Bimodal and unimodal P-wave groups are plotted together (n = 40).

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