Positive Correlation between P Wave Analysis and Severity of Heart Failure with Preserved and Reduced Ejection Fraction

Abstract

Purpose Two separate studies by Morris et al. in 1964 and then He at al. in 2017 were able to show a direct relationship between P wave analysis and valvular heart disease and ischemic stroke, respectively. We hope to continue this progress by establishing a relationship between P wave morphology, duration, PR interval, and P wave terminal force with the severity of Heart Failure with Reduced and Preserved Ejection Fraction in our patient population. Methods We retrospectively analyzed a specific subset of patients who were admitted to the hospital for decompensated heart failure. These patients were classified into either the Heart failure with preserved ejection fraction (HFpEF) or the heart failure with reduced ejection fraction (HFrEF) group after transthoracic echos were reviewed, with Syngo, using the current ASE guideline for diastolic dysfunction. Their admission ECGs were also reviewed, using MUSE, with specific attention paid to P wave analysis. We manually measured their p wave duration in sec, PR interval in sec, P wave morphology, and P wave height. The P wave terminal force was then calculated for each patient. All these patients were then compared to patient without any systolic or diastolic dysfunction. Results Our analysis showed a statistically significant correlation with specific P wave analysis in the each subgroup of heart failure patients, when compared to our control group. Patient's with HFpEF had a higher incidence of a parabolic p wave shape (p=0.04), while patient's with HFrEF had a higher incidence of bifid p wave shape (p=0.045). We also noted a significantly higher terminal force by over 11% in both our analysis group compare to control (HFpEF 11.9% vs HFrEF 11.3%; p=0.05). The terminal force cut off for each subgroup was higher than previously noted in prior studies. Subanalysis also yielded a direct correlation with terminal force and severity of heart failure in both HFpEF and HFrEF with a strong, positive, relative linear relationship (Pearson Correlation of 0.609 and r of 0.63) likely suggesting more severe remodeling of the atria as LV function declines. Conclusion Our retrospective analysis suggests another non-invasive diagnostic tool via P wave analysis from an EKG to help diagnose different forms of heart failure, such as HFpEF and HFrEF. Concurrently, calculation of the p wave terminal force can also help determine the severity of both systolic and diastolic heart failure.