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P-wave duration and dispersion in patients with peripheral edema and its amelioration.

Madias JE - Indian Pacing Electrophysiol J (2007)

Bottom Line: Although P-wave amplitudes and P-wave areas decreased with development of PERED (N = 16), and increased with its amelioration (N = 6), P-dur-mean before PERED was 66.8+/-14.5 ms, and at peak weight gain it was 65.2+/-11.9 ms, p = 0.66; also at peak weight gain and subsequent lowest weight, in the patients who lost weight, it was 66.5+/-9.9 ms and 72.3+/-12.0 ms, respectively, p = 0.38.Similarly the P-d prior to PERED was 62.3+/-25.2 ms, and at peak weight gain it was 74.3+/-29.3 ms, p = 0.09; also at peak weight and subsequent lowest weight, in the patients who lost weight, it was 58.8+/-34.2 ms, and 61.3+/-13.6 ms, respectively, p = 0.87.P-du-mean and P-d did not change in patients who developed PERED; their stability is attributed to the offsetting of the electrophysiologically-mediated real changes, by opposite apparent changes, imparted by PERED.

View Article: PubMed Central - PubMed

Affiliation: Mount Sinai School of Medicine, New York University, New York, NY, USA. madiasj@nychhc.org

ABSTRACT

Background: Attenuation of the P-wave amplitudes in patients with peripheral edema (PERED) has been recently reported, with P-waves regaining some of their amplitude in patients, who subsequently experienced amelioration of their PERED. Changes in the P-waves correlated with the corresponding alterations in the QRS complexes. Also since amplitudes and durations of QRS complexes changed in parallel in patients with PERED, it was hypothesized that similar changes in the P-wave amplitudes, mean P-wave duration (P-du-mean), and P-wave dispersion (P-d), would occur in such patients.

Methods: Measurements of P-wave amplitude, P-du-mean and P-d in patients who developed, or experienced alleviation, of PERED, were carried out and analyzed.

Results: Although P-wave amplitudes and P-wave areas decreased with development of PERED (N = 16), and increased with its amelioration (N = 6), P-dur-mean before PERED was 66.8+/-14.5 ms, and at peak weight gain it was 65.2+/-11.9 ms, p = 0.66; also at peak weight gain and subsequent lowest weight, in the patients who lost weight, it was 66.5+/-9.9 ms and 72.3+/-12.0 ms, respectively, p = 0.38. Similarly the P-d prior to PERED was 62.3+/-25.2 ms, and at peak weight gain it was 74.3+/-29.3 ms, p = 0.09; also at peak weight and subsequent lowest weight, in the patients who lost weight, it was 58.8+/-34.2 ms, and 61.3+/-13.6 ms, respectively, p = 0.87.

Conclusion: P-du-mean and P-d did not change in patients who developed PERED; their stability is attributed to the offsetting of the electrophysiologically-mediated real changes, by opposite apparent changes, imparted by PERED.

No MeSH data available.


Related in: MedlinePlus

Reproduction of the pertinent portion of the "Extended measurement Report" provided by the automated measurement program [3], with the values of measurements for all 12- ECG leads, and the calculated variables based on such measurements.
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Figure 1: Reproduction of the pertinent portion of the "Extended measurement Report" provided by the automated measurement program [3], with the values of measurements for all 12- ECG leads, and the calculated variables based on such measurements.

Mentions: Details on patients and study design can be found elsewhere [32]; variables used herein included the P-du-mean, maximum P-du (P-max), minimum P-du (P-min), the standard deviation of the P-du from all 12 ECG leads (P-du-SD) [33], all in ms, the mean P-wave area in "Ashman" units (P-area-mean) (1 Ashman unit = an area of 1.0 mm2) [3,34], the P-d (P-max - P-min, using all 12 ECG leads) in ms, the mean P-amp in mm (P-amp-mean), and the horizontal axis of the P-waves (P-horiz-axis) in degrees. Data on the P-wave frontal axis (P-fro-axis), ΣP in mm, P-R intervals, and heart rates has been reported previously [1]. The P-du-mean and mean P-area were calculated by summing the individual such P-wave values from all 12 ECG leads, provided by the automated program (HP, now Philips M1700A PageWriter model) [3]Figure 1) and dividing by 12. This automated measurement and interpretation program has been previously validated [35,36]. The software could measure P-wave duration in all 12 leads in 31 of 38 instances (16 from admission, 16 from the time of peak weight, and 6 from the time of lowest weight) (81.6%), which represented all 16 patients on admission, 9 of the 16 patients at the time of the peak weight, and all 6 patients, at the time of subsequent, to the time of the peak lowest weight, for the patients who lost weight. In the other 7 patients the software could measure only 10 leads (excluding V5 and V6) in patient #1, 11 leads (excluding III) in patients #4 and #13, 11 leads (excluding I) in patient #5, 7 leads (excluding aVL and V3-V6) in patient #11, 8 leads (excluding aVL and V4-V6) in patient #23, and 7 leads (excluding I, aVL and V4-V6) in patient #26. For calculation of the P-du-mean in instances with measurements of fewer than 12 leads the sums of the values of the P-wave durations, were divided by the number of the leads with successful measurement. Values of ΣP [1] (manual measurements) were used for comparisons with the mean P-wave amplitude (P-amp-mean), which was calculated as the sum of the values of all ECG leads, provided by the automated ECG program, divided by 12. For all above measurements data were obtained or calculated by taking in consideration the printed form of the "Extended Measurement Report" generated by the automated program [3], part of which is reproduced in the upper panel of Figure 1. Data acquisition was the same for all patients at baseline, the time of the peak weight gain, and the time of subsequent lowest weight (for patients who lost weight). The automated system does not generate records of the ECG measurements, with caliper markings indicating the onset and offset of P-waves, used in the measurement of P-wave duration, but only provides the numerical value of the measurements. The automated measurements of the P-wave are part of the overall ECG measurements of the HP ECG Analysis Program, and it is based on simultaneous 12-lead acquisition of the ECG. Calibration of the ECG recordings was 10 mm = 1.0 mV, and the paper speed was 25 mm/sec. Automated measurements of the variables provided inclusion of unbiased data for analysis. Figure 2 illustrates the minuscule amplitude and duration of P-waves particularly with PERED, which makes it impossible to measure manually, and explains the necessity of using automation in acquisition of parameters displayed in Figure 1. Serum K+, Ca++, Mg++, and HCO3 were monitored during the study.


P-wave duration and dispersion in patients with peripheral edema and its amelioration.

Madias JE - Indian Pacing Electrophysiol J (2007)

Reproduction of the pertinent portion of the "Extended measurement Report" provided by the automated measurement program [3], with the values of measurements for all 12- ECG leads, and the calculated variables based on such measurements.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1764906&req=5

Figure 1: Reproduction of the pertinent portion of the "Extended measurement Report" provided by the automated measurement program [3], with the values of measurements for all 12- ECG leads, and the calculated variables based on such measurements.
Mentions: Details on patients and study design can be found elsewhere [32]; variables used herein included the P-du-mean, maximum P-du (P-max), minimum P-du (P-min), the standard deviation of the P-du from all 12 ECG leads (P-du-SD) [33], all in ms, the mean P-wave area in "Ashman" units (P-area-mean) (1 Ashman unit = an area of 1.0 mm2) [3,34], the P-d (P-max - P-min, using all 12 ECG leads) in ms, the mean P-amp in mm (P-amp-mean), and the horizontal axis of the P-waves (P-horiz-axis) in degrees. Data on the P-wave frontal axis (P-fro-axis), ΣP in mm, P-R intervals, and heart rates has been reported previously [1]. The P-du-mean and mean P-area were calculated by summing the individual such P-wave values from all 12 ECG leads, provided by the automated program (HP, now Philips M1700A PageWriter model) [3]Figure 1) and dividing by 12. This automated measurement and interpretation program has been previously validated [35,36]. The software could measure P-wave duration in all 12 leads in 31 of 38 instances (16 from admission, 16 from the time of peak weight, and 6 from the time of lowest weight) (81.6%), which represented all 16 patients on admission, 9 of the 16 patients at the time of the peak weight, and all 6 patients, at the time of subsequent, to the time of the peak lowest weight, for the patients who lost weight. In the other 7 patients the software could measure only 10 leads (excluding V5 and V6) in patient #1, 11 leads (excluding III) in patients #4 and #13, 11 leads (excluding I) in patient #5, 7 leads (excluding aVL and V3-V6) in patient #11, 8 leads (excluding aVL and V4-V6) in patient #23, and 7 leads (excluding I, aVL and V4-V6) in patient #26. For calculation of the P-du-mean in instances with measurements of fewer than 12 leads the sums of the values of the P-wave durations, were divided by the number of the leads with successful measurement. Values of ΣP [1] (manual measurements) were used for comparisons with the mean P-wave amplitude (P-amp-mean), which was calculated as the sum of the values of all ECG leads, provided by the automated ECG program, divided by 12. For all above measurements data were obtained or calculated by taking in consideration the printed form of the "Extended Measurement Report" generated by the automated program [3], part of which is reproduced in the upper panel of Figure 1. Data acquisition was the same for all patients at baseline, the time of the peak weight gain, and the time of subsequent lowest weight (for patients who lost weight). The automated system does not generate records of the ECG measurements, with caliper markings indicating the onset and offset of P-waves, used in the measurement of P-wave duration, but only provides the numerical value of the measurements. The automated measurements of the P-wave are part of the overall ECG measurements of the HP ECG Analysis Program, and it is based on simultaneous 12-lead acquisition of the ECG. Calibration of the ECG recordings was 10 mm = 1.0 mV, and the paper speed was 25 mm/sec. Automated measurements of the variables provided inclusion of unbiased data for analysis. Figure 2 illustrates the minuscule amplitude and duration of P-waves particularly with PERED, which makes it impossible to measure manually, and explains the necessity of using automation in acquisition of parameters displayed in Figure 1. Serum K+, Ca++, Mg++, and HCO3 were monitored during the study.

Bottom Line: Although P-wave amplitudes and P-wave areas decreased with development of PERED (N = 16), and increased with its amelioration (N = 6), P-dur-mean before PERED was 66.8+/-14.5 ms, and at peak weight gain it was 65.2+/-11.9 ms, p = 0.66; also at peak weight gain and subsequent lowest weight, in the patients who lost weight, it was 66.5+/-9.9 ms and 72.3+/-12.0 ms, respectively, p = 0.38.Similarly the P-d prior to PERED was 62.3+/-25.2 ms, and at peak weight gain it was 74.3+/-29.3 ms, p = 0.09; also at peak weight and subsequent lowest weight, in the patients who lost weight, it was 58.8+/-34.2 ms, and 61.3+/-13.6 ms, respectively, p = 0.87.P-du-mean and P-d did not change in patients who developed PERED; their stability is attributed to the offsetting of the electrophysiologically-mediated real changes, by opposite apparent changes, imparted by PERED.

View Article: PubMed Central - PubMed

Affiliation: Mount Sinai School of Medicine, New York University, New York, NY, USA. madiasj@nychhc.org

ABSTRACT

Background: Attenuation of the P-wave amplitudes in patients with peripheral edema (PERED) has been recently reported, with P-waves regaining some of their amplitude in patients, who subsequently experienced amelioration of their PERED. Changes in the P-waves correlated with the corresponding alterations in the QRS complexes. Also since amplitudes and durations of QRS complexes changed in parallel in patients with PERED, it was hypothesized that similar changes in the P-wave amplitudes, mean P-wave duration (P-du-mean), and P-wave dispersion (P-d), would occur in such patients.

Methods: Measurements of P-wave amplitude, P-du-mean and P-d in patients who developed, or experienced alleviation, of PERED, were carried out and analyzed.

Results: Although P-wave amplitudes and P-wave areas decreased with development of PERED (N = 16), and increased with its amelioration (N = 6), P-dur-mean before PERED was 66.8+/-14.5 ms, and at peak weight gain it was 65.2+/-11.9 ms, p = 0.66; also at peak weight gain and subsequent lowest weight, in the patients who lost weight, it was 66.5+/-9.9 ms and 72.3+/-12.0 ms, respectively, p = 0.38. Similarly the P-d prior to PERED was 62.3+/-25.2 ms, and at peak weight gain it was 74.3+/-29.3 ms, p = 0.09; also at peak weight and subsequent lowest weight, in the patients who lost weight, it was 58.8+/-34.2 ms, and 61.3+/-13.6 ms, respectively, p = 0.87.

Conclusion: P-du-mean and P-d did not change in patients who developed PERED; their stability is attributed to the offsetting of the electrophysiologically-mediated real changes, by opposite apparent changes, imparted by PERED.

No MeSH data available.


Related in: MedlinePlus