BACKGROUND: P wave indices are an intermediate phenotype modulated by atrial conduction and electrophysiology. Their clinical correlates and association with all-cause mortality have received limited scrutiny. OBJECTIVE: To determine the relationship between P wave indices and cardiovascular and all-cause mortality in the National Health and Nutrition Examination Survey (NHANES), a highly representative United States sample. METHODS: NHANES III (1988-1994) quantified PR interval and P wave duration and amplitude. Mortality data through 2006 were obtained from National Death Index (NDI) records. RESULTS: Of 8,561 subjects with electrocardiograms (ECGs), 7,486 (mean age 60.0 ± 13.3 years., 51.9% women, 50.1% ethnic minorities) had ECGs in sinus rhythm, linked mortality data, and complete assessments. Over a median 8.6-year follow-up (range 0.1-12.2 years), there were 679 cardiovascular deaths and 1,559 all-cause mortality deaths. Older age, male sex, and higher body mass index were significantly associated with greater PR interval and P wave duration and with lower P wave amplitude. African Americans had higher mean values of all three P wave indices. In a multivariable model adjusting for cardiovascular risk factors, P wave duration was the only P wave index significantly associated with cardiovascular mortality (hazard ratio [HR] 1.13, per 1 standard deviation [SD], 95% confidence interval [CI] 1.04-1.23; P = .004) and all-cause mortality (HR 1.06 per 1 SD; 95% CI 1.00-1.13; P = .050). CONCLUSIONS: In a highly representative U.S. sample, P wave duration was significantly associated with increased cardiovascular and all-cause mortality. P wave duration may reflect subclinical disease and merits elucidation as a marker of risk for adverse outcomes.
BACKGROUND: P wave indices are an intermediate phenotype modulated by atrial conduction and electrophysiology. Their clinical correlates and association with all-cause mortality have received limited scrutiny. OBJECTIVE: To determine the relationship between P wave indices and cardiovascular and all-cause mortality in the National Health and Nutrition Examination Survey (NHANES), a highly representative United States sample. METHODS: NHANES III (1988-1994) quantified PR interval and P wave duration and amplitude. Mortality data through 2006 were obtained from National Death Index (NDI) records. RESULTS: Of 8,561 subjects with electrocardiograms (ECGs), 7,486 (mean age 60.0 ± 13.3 years., 51.9% women, 50.1% ethnic minorities) had ECGs in sinus rhythm, linked mortality data, and complete assessments. Over a median 8.6-year follow-up (range 0.1-12.2 years), there were 679 cardiovascular deaths and 1,559 all-cause mortality deaths. Older age, male sex, and higher body mass index were significantly associated with greater PR interval and P wave duration and with lower P wave amplitude. African Americans had higher mean values of all three P wave indices. In a multivariable model adjusting for cardiovascular risk factors, P wave duration was the only P wave index significantly associated with cardiovascular mortality (hazard ratio [HR] 1.13, per 1 standard deviation [SD], 95% confidence interval [CI] 1.04-1.23; P = .004) and all-cause mortality (HR 1.06 per 1 SD; 95% CI 1.00-1.13; P = .050). CONCLUSIONS: In a highly representative U.S. sample, P wave duration was significantly associated with increased cardiovascular and all-cause mortality. P wave duration may reflect subclinical disease and merits elucidation as a marker of risk for adverse outcomes.
Authors: Christian Jons; Arthur J Moss; Ilan Goldenberg; Judy Liu; Scott McNitt; Wojciech Zareba; Ming Qi; Jennifer L Robinson Journal: J Am Coll Cardiol Date: 2010-02-23 Impact factor: 24.094
Authors: Ethan J Anderson; Alan P Kypson; Evelio Rodriguez; Curtis A Anderson; Eric J Lehr; P Darrell Neufer Journal: J Am Coll Cardiol Date: 2009-11-10 Impact factor: 24.094
Authors: Jared W Magnani; Mary Ann Williamson; Patrick T Ellinor; Kevin M Monahan; Emelia J Benjamin Journal: Circ Arrhythm Electrophysiol Date: 2009-02
Authors: Susan Cheng; Michelle J Keyes; Martin G Larson; Elizabeth L McCabe; Christopher Newton-Cheh; Daniel Levy; Emelia J Benjamin; Ramachandran S Vasan; Thomas J Wang Journal: JAMA Date: 2009-06-24 Impact factor: 56.272
Authors: Ankit Maheshwari; Faye L Norby; Elsayed Z Soliman; M Chadi Alraies; Selcuk Adabag; Wesley T O'Neal; Alvaro Alonso; Lin Y Chen Journal: Am J Cardiol Date: 2017-02-09 Impact factor: 2.778
Authors: Tiia Istolahti; Antti Eranti; Heini Huhtala; Leo-Pekka Lyytikäinen; Mika Kähönen; Terho Lehtimäki; Markku Eskola; Ismo Anttila; Antti Jula; Antoni Bayés de Luna; Kjell Nikus; Jussi Hernesniemi Journal: Ann Med Date: 2020-03-14 Impact factor: 4.709
Authors: Marco Marano; Anna D'Amato; Antoni Bayés de Luna; Adrian Baranchuk Journal: Ann Noninvasive Electrocardiol Date: 2014-12-26 Impact factor: 1.468
Authors: Jared W Magnani; Lei Zhu; Faye Lopez; Michael J Pencina; Sunil K Agarwal; Elsayed Z Soliman; Emelia J Benjamin; Alvaro Alonso Journal: Am Heart J Date: 2014-10-22 Impact factor: 4.749
Authors: Jared W Magnani; Na Wang; Kerrie P Nelson; Stephanie Connelly; Rajat Deo; Nicolas Rodondi; Erik B Schelbert; Melissa E Garcia; Caroline L Phillips; Michael G Shlipak; Tamara B Harris; Patrick T Ellinor; Emelia J Benjamin Journal: Circ Arrhythm Electrophysiol Date: 2012-12-16
Authors: Alvaro Alonso; Elsayed Z Soliman; Lin Y Chen; David A Bluemke; Susan R Heckbert Journal: J Electrocardiol Date: 2013-02-26 Impact factor: 1.438