Abnormal P wave terminal force in lead V1 is correlated with adverse cardiac remodeling in patients with left ventricular noncompaction: A useful noninvasive indicator of disease severity

Abstract

Background

Abnormal P wave terminal force in lead V1 (PTFV1) has been associated with adverse outcomes in various cardiovascular conditions. However, the potential role of PTFV1 in patients with left ventricular noncompaction (LVNC) has not been reported. Therefore, this study aims to investigate the prevalence of PTFV1 in patients with LVNC and explore its possible association with abnormalities in both the left atrium (LA) and left ventricle (LV).

Methods

From January 2016 to December 2017, 93 patients diagnosed with LVNC via cardiovascular magnetic resonance (CMR) were enrolled in the study. Clinical, echocardiographic, CMR, and electrocardiogram data were retrospectively collected and analyzed independently.

Results

The mean age of the 93 patients at diagnosis was 44.3 ± 13.9 years, with 64.5 % being male. Abnormal PTFV1 was present in 23.6 % of the patients. Those with abnormal PTFV1 had significantly higher rates of NYHA functional class III or IV (86.4 % vs. 19.7 %, p < 0.001), LV thrombus (9.0 % vs. 4.2 %, p = 0.049), and late gadolinium enhancement (63.6 % vs. 33.8 %, p = 0.013). These patients also had significantly greater mitral regurgitation grades, larger LA and LV volume indices, and lower LV ejection fraction (LVEF). Receiver operating characteristic curve analysis showed moderate-to-high area under the curve (AUC) values (ranging from 0.72 to 0.83) for various indices in identifying abnormal PTFV1, with LVEF showing the highest AUC of 0.83. Binary logistic regression identified LVEF as the only independent factor associated with abnormal PTFV1 (OR = 0.89, p = 0.003).

Conclusion

Abnormal PTFV1, observed in approximately one-quarter of LVNC patients, is linked to more severe cardiac remodeling and dysfunction, and its presence can be predicted by a reduced LVEF.