The Relationship between the Left Atrial Volume and the Maximum P-wave and P-wave Dispersion in Patients with Congestive Heart Failure

PURPOSE: A maximum P-wave duration (Pmax) of > or = 110msec and a P-wave dispersion (PWD) > or = 40msec are accepted indicators of a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse, respectively. The left atrial (LA) volume has been reported to be strongly associated with a systolic and diastolic dysfunction and is considered to be an index of atrial remodeling. We aimed to investigate the relationship between LA volume and Pmax or PWD in patients with congestive heart failure (CHF). PATIENTS AND METHODS: Sixty-one patients with CHF were enrolled in this study. The study population was classified into four groups: two groups were divided according to the Pmax (> or = 110msec or or = 40msec or or = 110ms or a PWD > or = 40ms and those with a Pmax < 110ms or a PWD < 40ms. The LAVi was independently associated with a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse. The LAVi can be used to identify patients with a disturbance in interatrial conduction and an inhomogeneous propagation of the sinus impulse with reasonably good accuracy. CONCLUSION: We concluded that a disturbance in interatrial conduction and an inhomogenous propagation of the sinus impulse in patients with CHF is associated with an increase in the LA volume and a deleterious systolic and diastolic dysfunction.

A Case of Extensive Ventricular Wall Rupture from the Posterior Wall to the Ventricular Septum after Acute Myocardial Infarction Demonstrated by Real-Time 3D Echocardiography

2D echocardiography (2DE) is a well established tool for the diagnosis of the mechanical complications after acute myocardial infarction (AMI) such as free wall and ventricular septal rupture. However, the extension of the rupture and the relationship with contiguous anatomic structures may not be clearly defined by 2DE. Real-time 3D echocardiography (RT3DE) is known to provide surgical enface view allowing complete visualization of the cardiac structures and comprehension of their spatial orientations to other anatomic structures. Obtaining such information with RT3DE before operation in AMI patient with mechanical complication may be essential for the optimal surgical treatment. We report a case of extensive ventricular wall rupture from the posterior wall to the ventricular septum after AMI demonstrated by RT3DE.