P-wave indices as predictors of atrial fibrillation

Abstract Background P‐wave duration (PDURATION) and P‐wave area (PAREA) have been linked to risk of atrial fibrillation (AF), but they do not improve the efficacy of Framingham AF risk score. We suggest the incorporation of both variables in one index, the P‐wave area/P‐wave duration (PAREA/DURATION) index, which may be considered an expression of the average amplitude of the P wave that reflects aspects of P‐wave morphology. Objective To assess the prognostic value of P‐wave area/P‐wave duration index (PAREA/DURATION index) in lead II together with other P‐wave indices (PWIs) in incidence of AF in the Copenhagen Holter Study. Methods The study included 632 men and women, between 55 and 75 years with no apparent heart disease or AF. Baseline standard 12‐lead Electrocardiography (ECGs) were analyzed manually. Results The median follow‐up time was 14.7 (14.5;14.9) years. A total of 68 cases of AF and 233 cases of death were recorded. The restricted cubic spline method showed a U‐shaped association between PAREA/DURATION and rate of AF. The lowest quintile of PAREA/DURATION index in lead II was associated with increased rate of AF, HR 2.80 (1.64–4.79). The addition of the new index to the Framingham model for AF improved the model in this population. The PAREA in lead II in its lowest quintile was also associated with increased rate of AF, HR 2.16 (1.25–3.75), but did not improve the Framingham model. PDURATION and P‐wave terminal force (PTF) were not significantly associated with AF. Conclusion A flat P wave as expressed by a small PAREA/DURATION index in lead II is associated with increased rate of incident AF beyond known AF risk factors

Prognostic value of carotid ultrasound and computed tomography for predicting major adverse cardiovascular events in familial hypercholesterolaemia: A systematic review and meta-analysis

This systematic review’s primary aim is to identify, evaluate and synthesise quantitative evidence of carotid ultrasound, femoral ultrasound, coronary calcium scoring and computed tomography coronary angiography (prognostic factors) for the prediction of major cardiovascular events (outcomes) in asymptomatic patients with heterozygotic familial hypercholesterolemia (population)

Diagnostic accuracy of carotid and femoral ultrasound in detecting asymptomatic coronary atherosclerosis in patients with familial hypercholesterolaemia: A protocol for a systematic review and meta-analysis

The aim of this systematic review is therefore to identify, evaluate, and synthesize quantitative evidence of the use of carotid and femoral ultrasound as surrogate markers of subclinical coronary atherosclerosis in asymptomatic individuals with familial hypercholesterolemia as compared to coronary calcium scoring and computed tomography coronary angiography