Use of P wave duration elongation to predict the severity of coronary artery disease

Background:The aim of our study is to evaluate the effectiveness of the P wave duration elongation used for to determine revascularization needed critical coronary artery disease in the patients who applied our clinic with stable angina pectoris and underwent coronary angiography due to detected significant ischemia in the diagnıstic myocardial perfusion scintigraphy.Methods: After reviewing the patients with stable angina pectoris complaints who underwent coronary angiography as a result of determined ischemia by exercise stres test and MPS Gated Spect between 2008 to 2011 and total of 126 patients were enrolled in the study. P-wave duration (PWD) was measured using leads D2 and V5 at rest and recovery (after exercise), with 4 times magnified electrocardiographic printouts (100mm/s, 40mm/mV). The change in PWD was calculated as P-wave duration at recovery period minus P-wave duration at resting period (? = PWDrecovery ? PWDrest ). According to coronary angiography reports, to be considered critical coronary artery disease stenosis rate is determined ? %50 for LMCA and ? %70 for rest of the coronary arteries. Smaller stenosis rates than these values, coronary slow-flow and normal coronary angiography results are both accepted as unsignificant stenosis and patients are classified into 3 groups; noncritical stenosis, single vessel and multi vessel.Results: Single vessel and Multi vessel groups which has serious stenosis rates and their revascularization requirement indicated by coronary angiography results are correlated with PWD elongation. Roc Curve is used for to evaluate this correlation between the PWD elongation and determination of critical stenosis by the coronary angiography. Accordingly, 21,5ms. value is set as a cut off value. PWD elongation is correlated with critical coronary artery disease if pwd elongation is ? 21,5ms with 81%sensitivity and 80% specifity rates. PWD elongation has been analysed by correlation method with Gensini Score, age, LVEF and ST segment changes seperately and then it is found that PWD elongation has negative correlation with LVEF and has positive correlation with rest of the parameters.Conclusion: As a result this study states that PWD elongation value correlates with the coronary angiography confirmed critical coronary artery disease. PWD elongation value just one minute after the end of EST has significantly associated with revascularization needed critical coronary artery disease.