CHA2DS2-VASc score, P-wave indexes, and echocardiographic parameters in sinus rhythm patients without valvular heart disease

Demarchi, Amanda Vanessa; Armaganijan, Luciana Vidal; Moreira, Dalmo Antonio Ribeiro; Shinzato, Mariane Higa; Vilalva, Kelvin Henrique; Graffitti, Pablo Santos; Bertin, Rodrigo Augusto de Miranda; Vilhena, Mathias Antonio Haruno de; David, Murilo Amato; Carvalho, Guilherme Dagostin de

doi:10.1590/1806-9282.20230607

Acessibilidade / Reportar erro

Brasil

Revista da Associação Médica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 69 (9) • 2023 • https://doi.org/10.1590/1806-9282.20230607 copy

CHA2DS2-VASc score, P-wave indexes, and echocardiographic parameters in sinus rhythm patients without valvular heart disease

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The aim of this study was to evaluate the correlation between P-wave indexes, echocardiographic parameters, and CHA2DS2-VASc score in patients without atrial fibrillation and valvular disease.

METHODS:

This retrospective cross-sectional study included patients of a tertiary hospital with no history of atrial fibrillation, atrial flutter, or valve disease and collected data from June 2021 to May 2022. The exclusion criteria were as follows: unavailable medical records, pacemaker carriers, absence of echocardiogram report, or uninterpretable ECG. Clinical, electrocardiographic [i.e., P-wave duration, amplitude, dispersion, variability, maximum, minimum, and P-wave voltage in lead I, Morris index, PR interval, P/PR ratio, and P-wave peak time], and echocardiographic data [i.e., left atrium and left ventricle size, left ventricle ejection fraction, left ventricle mass, and left ventricle indexed mass] from 272 patients were analyzed.

RESULTS:

PR interval (RHO=0.13, p=0.032), left atrium (RHO=0.301, p<0.001) and left ventricle diameter (RHO=0.197, p=0.001), left ventricle mass (RHO=0.261, p<0.001), and left ventricle indexed mass (RHO=0.340, p<0.001) were positively associated with CHA2DS2-VASc score, whereas P-wave amplitude (RHO=-0.141, p=0.02), P-wave voltage in lead I (RHO=-0.191, p=0.002), and left ventricle ejection fraction (RHO=-0.344, p<0.001) were negatively associated with the same score. The presence of the Morris index was associated with high CHA2DS2-VASc (p=0.022).

CONCLUSION:

Prolonged PR interval, Morris index, increased left atrium diameter, left ventricle diameter, left ventricle mass, and left ventricle indexed mass values as well as lower P-wave amplitude, P-wave voltage in lead I, and left ventricle ejection fraction values were correlated with higher CHA₂DS₂-VASc scores.

Keywords
Heart function tests; Electrocardiography; Echocardiography; Risk factors

Variable	Category/ Measurements	Frequency (%)/ Measurements
Age	Mean (SD)	62.4 (12.6)
Age range	18–64	140 (51.5)
	65–74	89 (32.7)
	≥75	43 (15.8)
Gender	Male	118 (43.4)
Gender	Female	154 (56.6)
BMI (kg/m²)	Mean (SD)	28.4 (5.5)
HF		57 (21.0)
HTN		223 (82.0)
DM		93 (34.2)
Stroke/TIA		16 (5.9)
Atherosclerotic disease		96 (35.3)
Dyslipidemia		197 (72.4)
Hypothyroidism		43 (15.8)
Smoking	Smoker	15 (5.5)
	Former smoker	69 (25.4)
	Never smoker	188 (69.1)
Beta-blocker		185 (68.0)
Antiarrhythmic		49 (18.0)
LA (mm)	Mean (SD)	40.1 (5.1)
LVEF (%)	Median (variation)	62.0 (22–79)
LV (mm)	Median (variation)	50 (36–88)
LV mass (g)	Median (variation)	198 (36–464)
LV indexed mass (g/m²)	Median (variation)	113.1 (34–243)
Average PWD (ms)	Mean (SD)	110.3 (14.2)
P SD (ms)	Mean (SD)	14.4 (4.1)
P variability	Median (variation)	0.13 (0.03–0.24)
Maximum P (ms)	Mean (SD)	131.9 (15.2)
Minimum P (ms)	Mean (SD)	85.5 (16.1)
P dispersion (ms)	Median (variation)	44.0 (16–108)
PVL1 (mm)	Median (variation)	0.8 (0.3–2.2)
P amplitude (mm)	Median (variation)	1.1 (0.2–2.6)
PPRi	Median (variation)	0.69 (0.34–1.24)
P-wave peak time (ms)	Median (variation)	60 (28–100)
PRi (ms)	Median (variation)	172 (88–276)
Morris index		42 (15.4)
CHA₂DS₂-VASc	Median (variation)	3.0 (0–7)
CHA₂DS₂-VASc	0	5 (1.8)
	1	31 (11.4)
	2	67 (24.6)
	3	68 (25.0)
	4	59 (21.7)
	5	31 (11.4)
	6	10 (3.7)
	7	1 (0.4)
High CHA₂DS₂-VASc		193 (71.0)

Variable	Variation	Median	Mean (SD)	RHO	p-Value
Mean PWD (ms)	63–153.1	110.3	110.3 (14.2)	0.084	0.167
P dispersion (ms)	16–108	44	46.4 (13.5)	0.026	0.669
P amplitude (mm)	0.2–2.6	1.1	1.1 (0.4)	(-0.141)	0.020
PRi (ms)	88–276	172	174.4 (29.9)	0.130	0.032
PPRi	0.3–1.2	0.7	0.7 (0.1)	(-0.078)	0.200
P-wave peak time (ms)	28–100	60	59.0 (13.2)	(-0.027)	0.656
P SD (ms)	4.3–29.3	14.2	14.4 (4.1)	0.053	0.379
P Variability	0.03–0.24	0.13	0.13 (0.04)	0.027	0.662
PVL1 (mm)	0.3–2.2	0.8	0.8 (0.3)	(-0.191)	0.002
LA (mm)	25–57	40	40.1 (5.1)	0.301	<0.001
LVEF (%)	22–79	62	57.9 (11.0)	(-0.344)	<0.001
LV (mm)	36–88	50	51.6 (6.9)	0.197	0.001
LV mass (g)	36–464	198	209.5 (63.3)	0.261	<0.001
LV indexed mass (g/m²)	34–243	113.1	117.2 (31.6)	0.340	<0.001

Variable	Category/Measurements	CHA₂DS₂-VASc		p-Value
Variable	Category/Measurements	Low	High	p-Value
PPRi	Mean (SD)	0.7 (0.1)	0.7 (0.1)	0.153^* *p-value obtained by Student’s t-test.
Mean PWD (ms)	Mean (SD)	109.3 (13.3)	110.7 (14.6)	0.468^* *p-value obtained by Student’s t-test.
P SD (ms)	Mean (SD)	13.9 (4.1)	14.6 (4.2)	0.224^* *p-value obtained by Student’s t-test.
P variability	Median (variation)	0.13 (0.03–0.24)	0.13 (0.05–0.24)	0.292^ p-value obtained by the Mann-Whitney U test.
P-wave peak time (ms)	Median (variation)	60 (28–88)	60 (28–100)	0.946^ p-value obtained by the Mann-Whitney U test.
P dispersion (ms)	Median (variation)	44 (16–92)	48 (16–108)	0.339^ p-value obtained by the Mann-Whitney U test.
PVL1 (mm)	Median (variation)	0.8 (0.4–1.5)	0.7 (0.3–2.2)	0.220^ p-value obtained by the Mann-Whitney U test.
P amplitude (mm)	Median (variation)	1.1 (0.6–2.3)	1.1 (0.2–2.6)	0.183^ p-value obtained by the Mann-Whitney U test.
PRi (ms)	Median (variation)	164 (128–256)	176 (88–276)	0.020 ^ p-value obtained by the Mann-Whitney U test.
Morris index		6 (7.6)	36 (18.6)	0.022 ^* *p-value obtained by the chi-square test. LA: left atrium; LV: left ventricle; LVEF: left ventricular ejection fraction; PPRi: P/PR ratio; PRi: PR interval; PVL1: P-wave voltage in lead I; PWD: P-wave duration; SD: standard deviation. Statistically significant values are indicated in bold.
LA (mm)	Mean (SD)	36.7 (4.5)	41.5 (4.7)	<0.001 ^* *p-value obtained by Student’s t-test.
LVEF (%)	Median (variation)	64 (32–75)	60 (22–79)	<0.001 ^ p-value obtained by the Mann-Whitney U test.
LV (mm)	Median (variation)	49 (36–61)	51 (38–88)	<0.001 ^ p-value obtained by the Mann-Whitney U test.
LV mass (g)	Median (variation)	172 (53.8–341)	213 (36–464)	<0.001 ^ p-value obtained by the Mann-Whitney U test.
LV indexed mass (g/m²)	Median (variation)	99 (34–179.6)	118.7 (56.6–243)	<0.001 ^ p-value obtained by the Mann-Whitney U test.

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author: amandademarchi@id.uff.br