Relationship between electrical conduction and phasic left atrial function: P-wave signal-averaged electrocardiography and time-left atrial volume curve assessments using two-dimensional speckle-tracking echocardiography
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P-wave signal-averaged electrocardiography (P-SAECG) can detect imperceptible conduction abnormalities, and volume analysis using two-dimensional speckle-tracking echocardiography (2-DSTE) allows us to easily measure the phasic function of the left atrium (LA). Both conduction abnormalities and functional deformation of the LA may be linked to the clinical outcome; however, the exact relationship is unclear. The aim of this study was to investigate the relationship between the phasic function of the LA and electrical conduction using P-SAECG and 2-DSTE. The subjects were 112 male volunteers (age 46.9 ± 13.2 years) with normal cardiac function who underwent P-SAECG and 2-DSTE. The filtered p-wave duration (FPD) and the root-mean-square voltage for the last 20 ms (RMS20) on P-SAECG wave were measured in ms and μV, respectively. Total emptying function (EF) (reservoir function), passive EF (conduit function), and active EF (booster pump function) of the LA were calculated as percentages to evaluate phasic LA function using 2DSTE. The mean FPD was 134.3 ± 11.7 ms and the mean RMS20 was 4.59 ± 2.39 μV. The mean total EF was 60.5 ± 13.1%, mean passive EF was 39.4 ± 13.9%, and mean active EF was 35.1 ± 13.9%. FPD had a negative correlation with passive EF (r = − 0.20, p = 0.039). FPD showed no significant relationship with total EF (r = − 0.03, p = 0.78) or active EF (r = 0.13, p = 0.18). There was a significant association between RMS20 and passive EF (r = 0.19, p = 0.048); however, no there was no correlation between RMS20 and total EF (r = 0.12, p = 0.23), or between RMS20 and passive EF (r = − 0.02, p = 0.86). In multivariate regression analysis, passive EF was an independent factor that influenced FPD duration. This study indicated that FPD was associated with conduit function, which includes phasic LA function. Therefore, electrical conduction of the LA and left ventricular diastolic function are closely related. In the clinical setting, when conduction abnormalities are detected, lifestyle measures or interventions can be applied to reduce cardiovascular risk.
KeywordsLeft atrium Signal-averaged electrocardiography Speckle-tracking echocardiographic imaging
We are very grateful to Nakamura M, MSc for supervising the P-SAECG procedures and acquiring data in our electrocardiography laboratory. We would also like to thank Sato N, MSc, Aoki M, MSc, Miyazaki M, MSc, Nagaya M, MSc, Nakamura J, MSc, Onishi, MSc Otsuka, M MSc, Saeki M, MSc, Shouji T, MSc, and Yamamoto I, MSc for providing the experimental equipment. We would like to thank Ms. Nakanishi T for assisting in the preparation of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 3.Tanaka S, Noda T, Kubota T, Segawa T, Iwama M, Kawasaki M, Nishigaki T, Watanabe S, Minagawa T, Minatoguchi S (2015) Evaluation of circadian rhythm of atrial late potentials continuously measured by digital Holter monitor. Ther Res 36:799–807Google Scholar
- 4.Yodogawa K, Seino Y, Ohara T, Hayashi M, Miyauchi Y, Katoh T, Mizuno K (2013) Prediction of atrial fibrillation after ischemic stroke using P-wave signal averaged electrocardiography. J Cardiol 61(49):52Google Scholar
- 5.Shimada K, Tomita T, Kamijo Y, Higuchi M, Ito K, Koizumi Y, Yamamoto K, Aizawa K, Koshikawa M, Kasai H, Izawa A, Miyashita Y, Kumazaki S, Koyama J, Ikeda U (2012) Hemodialysis-induced P-wave signal-averaged electrocardiogram alterations are indicative of vulnerability to atrial arrhythmias. Circ J 76:612–617CrossRefGoogle Scholar
- 7.Girasis C, Vassilikos V, Efthimiadis GK, Papadopoulou SL, Dakos G, Dalamaga EG, Chouvarda I, Giannakoulas G, Kamperidis V, Paraskevaidis S, Maglaveras N, Karvounis HI, Parcharidis GE, Styliadis IH (2013) Patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation: advanced echocardiographic evaluation of the left atrium combined with non-invasive P-wave analysis. Eur Heart J Cardiovasc Imaging 14:425–434CrossRefGoogle Scholar
- 9.Nagaya M, Kawasaki M, Tanaka R, Onishi N, Sato N, Ono K, Watanabe T, Minatoguchi S, Miwa H, Goto Y, Hirose T, Arai M, Noda T, Watanabe S, Minatoguchi S (2013) Quantitative validation of left atrial structure and function by two-dimensional and three-dimensional speckle tracking echocardiography: a comparative study with three-dimensional computed tomography. J Cardiol 62:188–194CrossRefGoogle Scholar
- 10.Hirose T, Kawasaki M, Tanaka R, Ono K, Watanabe T, Iwama M, Noda T, Watanabe S, Takemura G, Minatoguchi S (2012) Left atrial function assessed by speckle tracking echocardiography as a predictor of new-onset non-valvular atrial fibrillation: results from a prospective study in 580 adults. Eur Heart J Cardiovasc Imaging 13:243–250CrossRefGoogle Scholar
- 11.Kojima T, Kawasaki M, Tanaka R, Ono K, Hirose T, Iwama M, Watanabe T, Noda T, Watanabe S, Takemura G, Minatoguchi S (2011) Left atrial global and regional function in patients with paroxysmal atrial fibrillation has already been impaired before enlargement of left atrium: velocity vector imaging echocardiography study. Eur Heart J Cardiovasc Imaging 13:227–234CrossRefGoogle Scholar
- 12.Farzaneh-Far A, Ariyarajah V, Shenoy C, Dorval JF, Kaminski M, Curillova Z, Wu H, Brown KB, Kwong RY (2011) Left atrial passive emptying function during dobutamine stress MR imaging is a predictor of cardiac events in patients with suspected myocardial ischemia. JACC Cardiovasc Imaging 4:378–388CrossRefGoogle Scholar
- 13.Dodson JA, Neilan TG, Shah RV, Farhad H, Blankstein R, Steigner M, Michaud GF, John R, Abbasi SA, Jerosch-Herold M, Kwong RY (2014) Left atrial passive emptying function determined by cardiac magnetic resonance predicts atrial fibrillation recurrence after pulmonary vein isolation. Circ Cardiovasc Imaging 7:586–592CrossRefGoogle Scholar
- 22.Kubota T, Kawasaki M, Takasugi N, Takeyama U, Ishihara Y, Okubo M, Yamaki T, Ojio S, Aoyama T, Arai M, Nishigaki K, Takemura G, Fujiwara H, Minatoguchi S (2009) Evaluation of left atrial degeneration for the prediction of atrial fibrillation: usefulness of integrated backscatter transesophageal echocardiography. JACC Cardiovasc Imaging 2:1039–1047CrossRefGoogle Scholar
- 23.Kubota T, Kawasaki M, Takasugi N, Imai H, Ishihara Y, Okubo M, Takahashi S, Sato H, Nishigaki K, Takemura G, Minatoguchi S (2012) Left atrial pathological degeneration assessed by integrated backscatter transesophageal echocardiography as a predictor of progression to persistent atrial fibrillation: results from a prospective study of three-years follow-up. Cardiovasc Ultrasound 10:28–34CrossRefGoogle Scholar