Evaluation of electrocardiographic P wave parameters in predicting long-term atrial fibrillation in patients with acute ischemic stroke.

BACKGROUND: Electrocardiographic parameters, such as P wave peak time (PWPT), P wave duration (PWD), and P wave amplitude in lead DI, have been utilized to assess left atrial anomalies linked to the development of atrial fibrillation (AF) in different cohort settings. OBJECTIVE: To compare electrocardiographic parameters, such as P waves, in predicting long-term AF risk in acute ischemic stroke cases. METHODS: The data of 231 consecutive acute ischemic stroke cases were retrospectively collected. Two independent cardiologists interpreted the electrocardiography recordings for PWPT, PWD, and P wave amplitude in lead DI. The median follow-up study period was 16 (interquartile range [IQR]: 11-24) months. RESULTS: In total, AF was detected in 43 (18.6%) cases. All studied P wave parameters were found to be statistically significant in cases with AF. Based on multivariable logistic regression analysis, dementia, left atrium volume index, PWD (razão de chances [RC]: 1.11; 95% confidence interval [CI]: 1.058-1.184; p = 0.003), PWPT in lead DII (RC: 1.030; 95%CI: 1.010-1.050; p = 0.003), and advanced interatrial block morphology were independent predictors of long-term AF. P wave duration had the highest area under the curve value, sensitivity, and specificity for long-term AF in such cases compared with the other P wave parameters. CONCLUSIONS: Our head-to-head comparison of well-known P wave parameters demonstrated that PWD might be the most useful P wave parameter for long-term AF in acute ischemic stroke cases.

ANTECEDENTES: Parâmetros eletrocardiográficos, como tempo de pico da onda P (PWPT, na sigla em inglês), duração da onda P (PWD, na sigla em inglês) e amplitude da onda P na derivação DI, têm sido utilizados para avaliar anomalias atriais esquerdas ligadas ao desenvolvimento de fibrilação atrial (FA) em diferentes cenários de coortes. OBJETIVO: Comparar os parâmetros eletrocardiográficos destas ondas P na predição do risco de FA de longo prazo em casos de acidente vascular cerebral (AVC) isquêmico agudo. MéTODOS: Os dados de 231 casos consecutivos de AVC isquêmico agudo foram coletados retrospectivamente. Dois cardiologistas independentes interpretaram os registros eletrocardiográficos para PWPT, PWD e amplitude da onda P na derivação DI. O período médio do estudo de acompanhamento foi de 16 (intervalo interquartil [IQR, na sigla em inglês]: 11­24) meses. RESULTADOS: No total, FA foi detectada em 43 (18,6%) casos. Todos os parâmetros da onda P estudados foram considerados estatisticamente significativos nos casos com FA. Com base na análise de regressão logística multivariável, demência, índice de volume do átrio esquerdo, PWD (razão de chances [RC]: 1,112; intervalo de confiança [IC] 95%: 1,058­1,184; p = 0,003), PWPT na derivação DII (RC: 1,030; IC95%: 1,010­1,050; p = 0,003) e avançada morfologia do bloqueio interatrial foram preditores independentes de FA de longo prazo. A PWD teve a maior área sob o valor da curva, sensibilidade e especificidade para FA de longo prazo em tais casos em comparação com os outros parâmetros da onda P. CONCLUSõES: Nossa comparação direta de parâmetros da onda P bem conhecidos demonstrou que a PWD pode ser o parâmetro da onda P mais útil para FA de longa duração em casos de AVC isquêmico agudo.

Mean serum D-dimer level to predict in-hospital mortality in COVID-19.

OBJECTIVE: The prognostic effect of the mean serum D-dimer levels, which was calculated from the first five days of hospitalization of the patients, has not been elucidated. This study aimed to evaluate the effect of mean D-dimer level about in-hospital mortality in patients hospitalized due to coronavirus disease-2019 (COVID-19) infection. METHODS: In this observational retrospective study, we examined the in-hospital prognostic value of mean D-dimer [D-dimerfirst day+D-dimerthird day+D-dimerfifth day)/3 on 240 consecutive adult patients with COVID-19. Patients were stratified into tertiles according to their mean D-dimer starting from the lowest one. In-hospital mortality rates were compared between tertiles and the power of the mean D-dimer level was also presented by a receiver operating curve analysis. RESULTS: After adjustment for confounding baseline variables, mean D-dimer in tertile 3 was associated with 4.2-fold hazard ratio of in-hospital mortality (odds ratio [OR] 4.2; 95% confidence interval [CI] 1.8-20.1, p<0.001). A receiver-operating curve analysis revealed that the optimal cutoff value of the mean D-dimer to predict in-hospital mortality was 779 µg/L with 77% sensitivity and 83% specificity (area under the curve [AUC] 0.87; 95%CI 0.81-0.94; p<0.001). CONCLUSION: Patients with a higher mean D-dimer level should be followed-up more closely as they may be a candidate for a more aggressive treatment modality, such as biologic agents or convalescent plasma.