P wave analysis in ischaemic heart disease. An echocardiographic, haemodynamic, and angiographic assessment.

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Abstract
Men (52) with stable angina pectoris, without associated valvular heart disease or congestive failure, were studied to assess the ECG P wave abnormalities and their relation to left atrial size, pressure and left ventricular function. Their mean age was 52 yr. Duration of P waves in leads II, III and aVF and the P terminal force in V1 were examined. Echocardiograms were obtained to assess left atrial size and left atrial-aortic ratio. These measurements were also made in 33 normal subjects. Mean pulmonary artery wedge pressure at rest and exercise, left ventricular asynergy, ejection fraction and severity of coronary artery disease were determined in all 52 patients. P terminal force more negative than -0.02 mm s was noted in 69% of coronary artery disease patients but in none of the normal subjects. P terminal force correlated with exercise pulmonary artery mean wedge pressure but not with left atrial size. P wave duration in lead II did not correlate with pulmonary artery mean wedge pressure or left atrial size. P terminal force correlated with left ventricular contraction abnormality, but not with ejection fraction or number of vessels diseased. Chronic intermittent increases in left atrial pressure in association with angina pectoris apparently result in left atrial hypertrophy, which is responsible for the increased magnitude of P terminal force in V1 in patients with ischemic heart disease.