Digital electrocardiogram-measured P-wave duration and hypertensive heart disease are associated with cardiovascular events in patients with cardiovascular risks.

Prolonged P-wave duration on electrocardiogram (ECG) quantitatively reflects atrial remodeling and is associated with atrial fibrillation, cardiovascular death. We examined the association between P-wave duration and the risk of cardiovascular events with and without left ventricular hypertrophy (LVH) on ECG. The COUPLING Study, which examined prognosis in a Japanese population at cardiovascular risk, included 4288 subjects for whom digital ECG analysis was available. The primary event was a composite endpoint of stroke, ischemic heart disease, sudden death, hospitalization for heart failure, and aortic dissection. The cutoff value of the P-wave in ECG was 140 ms, and patients were divided into two groups: a control group with normal P-wave duration (n = 3975) and a prolonged P-wave duration group (n = 313). The association between prolonged P-wave duration and cardiovascular events was investigated in the presence of LVH using the Cornell product criteria for ECG. The mean age of subjects was 69 ± 11 years, and 50% were male. The median follow-up period was 5.0 years, and primary events were observed in 178 patients. The hazard ratio of primary events for prolonged P-wave duration was 2.20 (95% confidence interval [CI] 1.47-3.29, p < 0.001) after adjusting for age, gender, and comorbidity. In patients without LVH, prolonged P-wave duration was associated with a 1.86-fold higher primary endpoint risk (95% CI 1.17-2.96, p = 0.008), while prolonged P-wave duration was associated with a 2.76-fold higher primary event risk in patients with LVH (95% CI 1.10-6.89, p = 0.030), and the association was stronger in patients with LVH on ECG (synergistic effect: p = 0.007). Cardiovascular risk factors can advance atherosclerosis. Elevated sympathetic nerve activity affects the development of atrial fibrillation, and the renin-angiotensin-aldosterone system affects atrial and ventricular filling pressures as well as volume overload. In these processes, prolonged P-wave, reflecting atrial remodeling, and BNP, reflecting impaired ventricular function, indicates that atherosclerosis is developing. Prolonged P-wave in advanced ECG-LVH is a risk for the occurrence of cardiovascular events.