Accuracy of ECG Criteria for Atrial Enlargement
Author Information
Author(s): Tsao Connie W, Josephson Mark E, Hauser Thomas H, O'Halloran T David, Agarwal Anupam, Manning Warren J, Yeon Susan B
Primary Institution: Harvard-Thorndike Laboratory and the Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School
Hypothesis
We sought to determine the accuracy of the ECG to predict anatomic atrial enlargement as determined by volumetric cardiovascular magnetic resonance (CMR).
Conclusion
The presence of at least one ECG criteria for left atrial enlargement is sensitive but not specific for anatomic left atrial enlargement.
Supporting Evidence
- The prevalence of CMR left atrial enlargement was 28% and right atrial enlargement was 11%.
- ECG criteria for left atrial enlargement had a sensitivity of 90% but a specificity of only 21%.
- Individual ECG criteria for left atrial enlargement were highly specific but not sensitive.
Takeaway
Doctors used ECG tests to see if they could tell if a patient's heart's upper chambers were too big, and found that while the tests were good at saying when they were big, they weren't very good at saying when they weren't.
Methodology
ECG criteria for left and right atrial enlargement were compared to CMR atrial volume index measurements for 275 consecutive subjects referred for CMR.
Potential Biases
The study did not adjust for other factors affecting P wave morphology, such as the use of sodium channel blocking medications.
Limitations
The study was noninvasive and could not measure atrial pressures, which may also affect the P wave.
Participant Demographics
The study included 275 subjects, 67% males, with an average age of 51 years.
Statistical Information
P-Value
0.023
Confidence Interval
1.2 to 7.3
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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