P Wave Peak Time for Predicting an Increased Left Atrial Volume Index in Hemodialysis Patients

Abstract

<b><i>Objective:</i></b> An increased left atrial volume index (LAVI) is related to increased mortality in hemodialysis patients. In the present study, we evaluated the association between the LAVI and the P wave peak time (PWPT), a newly introduced electrocardiographic parameter, in hemodialysis patients. <b><i>Methods:</i></b> The study population was made up of 79 hemodialysis patients with a mean age of 53 ± 18 years (55.7% were males). These patients were divided into a normal LAVI (≤28 mL/m<sup>2</sup>) group (<i>n</i> = 45) and an increased LAVI (>28 mL/m<sup>2</sup>) group (<i>n</i> = 34). The demographic, clinical, laboratory, echocardiographic, and electrocardiographic variables of the groups were compared. <b><i>Results:</i></b> The P wave terminal force from lead V1, P wave dispersion and PWPTs obtained from leads V1 and D2 (PWPT<sub>D2</sub>) were significantly higher in the patients with increased LAVIs. In multivariable analysis, only the PWPT<sub>D2</sub>was an independent predictor of an increased LAVI (odds ratio = 1.117, 95% CI = 1.052–1.185, <i>p</i> < 0.001). The receiver-operating characteristic curve analysis showed that the best PWPT<sub>D2</sub> cutoff value for predicting an increased LAVI was 60 ms, with a sensitivity of 76.5% and a specificity of 66.7% (area under the curve = 0.736, 95% CI = 0.625–0.829, <i>p</i> < 0.001). <b><i>Conclusion:</i></b> This study showed that a prolonged PWPT<sub>D2</sub> was independently associated with an increased LAVI in hemodialysis patients. Therefore, measuring the PWPT<sub>D2</sub> duration on an electrocardiogram may help define high-risk hemodialysis patients with increased LAVIs.