American Journal of Cardiology
Volume 105, Issue 10 , Pages 1365-1370 , 15 May 2010

Usefulness of P-Wave Duration to Identify Myocardial Ischemia During Exercise Testing

  • Jonathan C. Maganis, BA

      Affiliations

    • Memorial Heart and Vascular Institute, Long Beach Memorial Medical Center, Long Beach, California
  • ,
  • Bikash Gupta, MD

      Affiliations

    • Memorial Heart and Vascular Institute, Long Beach Memorial Medical Center, Long Beach, California
  • ,
  • Sherief H. Gamie, MD

      Affiliations

    • Memorial Heart and Vascular Institute, Long Beach Memorial Medical Center, Long Beach, California
  • ,
  • Judith J. LaBarbera, MD

      Affiliations

    • Memorial Heart and Vascular Institute, Long Beach Memorial Medical Center, Long Beach, California
  • ,
  • Ronald H. Startt-Selvester, MD

      Affiliations

    • Memorial Heart and Vascular Institute, Long Beach Memorial Medical Center, Long Beach, California
  • ,
  • Myrvin H. Ellestad, MD

      Affiliations

    • Memorial Heart and Vascular Institute, Long Beach Memorial Medical Center, Long Beach, California
    • University of California, Irvine, School of Medicine, Division of Cardiology, Irvine, California
    • Corresponding Author InformationCorresponding author: Tel: 562-933-3374; fax: 562-933-3344

Received 14 September 2009 ,Revised 20 December 2009 ,Accepted 20 December 2009.

References 

  1. Feil H, Siegel M. Electrocardiographic changes during attacks of angina pectoris. Am J Med Sci. 1928;175:225
  2. Guyton RA, McClenathan JH, Michaelis LL. Evolution of regional ischemia distal to a proximal coronary stenosis. Am J Cardiol. 1977;40:381
  3. Heikkila J, Hugenholtz G, Tabakin BS. Prediction of left heart filling pressure and its sequential change in acute myocardial infarction from the terminal force of the P wave. Br Heart J. 1973;35:142–151
  4. Durrer D, van Dam RTh, Freud GE, Janse MJ, Meijler FL, Arzbaecher RC. Total excitation of the isolated human heart. Circulation. 1970;41:899–912
  5. Selvester R, Haywood LJ. High gain, high frequency atrial vectorcardiograms in normal subjects and in patients with atrial enlargement. Am J Cardiol. 1969;24:8–17
  6. Selvester RH, Pearson RB. High-gain averaged atrial vectorcardiograms. In: Proceedings of the 11th International Vectorcardiography Symposium. Amsterdam, The Netherlands: North Holland; 1971;p. 689–696
  7. Myrianthiefs MM, Ellestad MH, Startt-Selvester RH, Crump R. Significance of signal-averaged P-wave changes during exercise in patients with coronary artery disease and correlation with angiographic findings. Am J Cardiol. 1991;68:1619–1624
  8. Myrianthiefs MM, Shandling AH, Startt-Selvester RH, Bernstein SB, Crump R, Lorenz LM, et al. Analysis of the signal-averaged p-wave duration in patients with percutaneous coronary angioplasty-induced myocardial ischemia. Am J Cardiol. 1992;70:728–732
  9. Morris JJ, Estes EH, Whalen RE, Thompson HD, McIntosh HD. P-wave analysis in valvular heart disease. Circulation. 1964;29:242–248
  10. Sigwart U, Grbic M, Goy JJ, Kappenberger L. Left atrial function in acute transient left ventricular ischemia produced during percutaneous transluminal coronary angioplasty of the left anterior descending coronary artery. Am J Cardiol. 1990;65:282–286
  11. Furukawa K, Kitamura H, Nishida K, Yamada C, Niki S, Sugihara H, et al. Simultaneous changes of left ventricular and left atrial size and function in normal subjects during exercise. Jpn Heart J. 1984;25:487–497
  12. Ellestad MH. Stress echocardiography. In:  Ellestad MH editors. Stress Testing: Principles and Practice. 5th ed. New York, New York: Oxford University Press; 2003;p. 128
  13. Mishkin FS. Radionuclide techniques in stress testing. In:  Ellestad MH editors. Stress Testing: Principles and Practice. 5th ed. New York, New York: Oxford University Press; 2003;p. 464
  14. Polizos G, Ellestad MH. The value of upsloping ST depression in diagnosing myocardial ischemia. Ann Noninvas Electrocardiol. 2006;11:237–240
  15. Ballok ZE. Nuclear cardiology. Heart Lung Circ. 2005;14(suppl):S27–S30
  16. Ragosta M, Bishop AH, Lipson LC, Watson DD, Gimple LW, Sarembock IJ, et al. Comparison between angiography and fractional flow reserve versus single-photon emission computed tomographic myocardial perfusion imaging for determining lesion significance in patients with multivessel coronary disease. Am J Cardiol. 2007;99:896–902
  17. Ravipati G, Aronow WS, Lai H, Shao J, DeLuca AJ, Weiss MB, et al. Comparison of sensitivity, specificity, positive predictive value and negative predictive value of stress testing versus 64-multislice coronary computed tomography angiography in predicting obstructive coronary artery disease diagnosed by coronary angiography. Am J Cardiol. 2008;101:774–775
  18. Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA. 2007;298:317–323
  19. Dunbar CC, Saul BI, Kassotis J, Badillo L. Usefulness of P-wave morphology during submaximal treadmill exercise to predict coronary artery disease. Am J Cardiol. 2005;96:781–783

 This study is funded by the Memorial Medical Center Foundation, Long Beach, CA.

PII: S0002-9149(10)00067-6

doi: 10.1016/j.amjcard.2009.12.060

American Journal of Cardiology
Volume 105, Issue 10 , Pages 1365-1370 , 15 May 2010