# Prevalence, associated factors, and prognostic value of P wave abnormality in patients with coronary artery disease

## TL;DR

This study shows that abnormal P-wave terminal force in V1 (PTFV1) is a strong predictor of poor outcomes in patients with coronary artery disease.

## Contribution

The study demonstrates that PTFV1 is an independent risk factor for adverse cardiovascular outcomes in CAD patients.

## Key findings

- 18.8% of CAD patients had abnormal PTFV1, which was linked to worse cardiovascular profiles and more advanced CAD.
- Abnormal PTFV1 was independently associated with a 2.38-fold higher risk of cardiac death or heart failure hospitalization.
- PTFV1 could improve early and cost-effective risk stratification for CAD patients.

## Abstract

P-wave terminal force in V1 (PTFV1) on electrocardiography is an easily available and cost-effective surrogate marker reflecting myocardial electrical and structural remodeling. An abnormal PTFV1 was recently suggested to be a reliable predictor of adverse cardiovascular events, whereas its performance in the setting of coronary artery disease (CAD) remains unknown.

We retrospectively investigated 3147 patients with CAD who underwent percutaneous coronary intervention at our institution. Abnormal PTFV1 was defined as PTFV1 >0.04 mm⋅s. The primary outcome was a composite of cardiac death and heart failure hospitalization. The Cox proportional hazard models were constructed to investigate the association between PTFV1 and clinical outcome.

Among the study population, 592 (18.8 %) patients had abnormal PTFV1. Patients with abnormal PTFV1 had worse atherosclerotic and cardiovascular profiles, higher concentrations of brain natriuretic peptide and C-reactive protein, and more advanced CAD than those with normal PTFV1 (p < 0.05). The abnormal PTFV1 group had more pronounced left ventricular and atrial remodeling than normal PTFV1 group (p < 0.05), but the association between left atrial size and PTFV1 was not significant after multivariable adjustment (p = 0.355). During a median follow-up of 5.2 years, patients with abnormal PTFV1 more frequently experienced the primary outcome than those with normal PTFV1 (log-rank p < 0.001). Abnormal PTFV1 carried a significant risk for the primary outcome independent of baseline characteristics, biomarkers, and angiographic features (adjusted hazard ratio 2.38, p < 0.001).

In patients with CAD who undergo percutaneous coronary intervention, abnormal PTFV1 is a robust and independent risk factor for adverse cardiovascular outcomes.

Image 1

•Among patients with coronary artery disease (CAD), 18.8 % had abnormal P-wave terminal force in V1 (PTFV1).•Patients with abnormal PTFV1 were accompanied by more advanced myocardial remodeling and a greater burden of CAD.•Abnormal PTFV1 carried an independent risk for adverse outcomes including cardiac death and heart failure hospitalization.•The prognostic value of PTFV1 could enhance early, accessible, and economical risk stratification in patients with CAD.

Among patients with coronary artery disease (CAD), 18.8 % had abnormal P-wave terminal force in V1 (PTFV1).

Patients with abnormal PTFV1 were accompanied by more advanced myocardial remodeling and a greater burden of CAD.

Abnormal PTFV1 carried an independent risk for adverse outcomes including cardiac death and heart failure hospitalization.

The prognostic value of PTFV1 could enhance early, accessible, and economical risk stratification in patients with CAD.