Abstract TMP91: Pre-Sepsis P-wave Terminal Force in Lead V1 (PTFV1) as a Predictor of Atrial Fibrillation, In-Hospital Mortality, and Cognition in Sepsis Patients

Abstract

Introduction: Enlarged P-wave terminal force in lead V1 (PTFV1) >5000 μV*ms is a long-term predictor of the left atrial abnormality such as atrial fibrillation (AF), cognitive dysfunction, and stroke at age ≤ 60. Sepsis patients are at high risk of cardiac dysfunction, AF, stroke, and impaired cognition acutely and longitudinally, but predictive value pre-sepsis PTFV1 has not been studied. Hypothesis: Higher PTFV1 before sepsis onset is associated with AF events, left atrial enlargement, mortality, and 1-year cognitive impairment in patients who developed sepsis. Methods: Patients with acute sepsis were prospectively screened and enrolled in an observational study years 2015-2019. Of the 360 consented, 287 had pre-sepsis electrocardiograms (ECG), and 272 were evaluable. PTFV1 was measured using the Mitutoyo 500-195-30CAL Absolute Digimatic Caliper. Left atrial diameter index (LADI) pre-sepsis and post enrollment were recorded (median of 2 days [interquartile range (IQR) 1-13]). Occurrence of AF was assessed on the next available ECG, 3 days [IQR 1-11] post-enrollment. Cognitive function at 1-year follow-up was assessed by the mini-mental state examination (MMSE) and the Hopkins Verbal Learning test (HVLT). Statistical significance was evaluated using linear and logistic univariate regression. Results: In this cohort, the median age was 63 years [IQR 53-71], 44% women. The median PTVF1, LADI at pre-sepsis and follow up were 3219 μV*ms [IQR 0 - 5487], 1.86 cm/mm 2 [IQR 1.58 - 2.14], and 1.89 cm/mm 2 [IQR 1.59 - 2.17], respectively. Pre-sepsis PTFV1 was > 5,000 μV*ms in 32%. Elevated PTFV1 at age ≥ 60 was not associated with AF (p=0.06) or in-hospital mortality (p=0.17). Similarly, high PTFV1 at age < 60 was not associated in-hospital mortality (p=0.50), and only 3 in this cohort had AF. There was no association with pre-sepsis LADI (p=0.55), follow-up LADI (p=0.70), MMSE (p=0.35), or HVLT (p=0.78) and PTFV1. Conclusions: Here, PTFV1 values were not associated with AF or measures of cognitive impairment. While our findings differ from other longitudinal studies, the early time interval and setting of sepsis in our study is unique. Future studies will include multivariate analysis and evaluation of long term outcome measures linked to PTFV1 such as stroke.