Objective: The aim of the study was to investigate the impact of
P-maximum and P-wave dispersion on the long term clinical outcome after
successful percutaneous balloon mitral valvuloplasty (PBMV) in patients
with mitral stenosis (MS) and sinus rhythm. Also to test the correlation between
P-variables and right ventricular function and pulmonary artery pressure before
and after PMBV. Methods: Eighty-five patients undergoing PMBV were enrolled
in this study. We evaluated P-maximum, P-minimum and P-wave dispersion before
and one month after PBMV. We studied the changes in pulmonary arterial pressure
(PAP), left atrial (LA) dimension, mitral diastolic gradient, and mitral valve
area, in addition to the changes in right ventricular function utilizing tissue
Doppler assessment both before and after PMBV, in addition the role of the
P-wave dispersion in predicttion of late cardiac events. Results: There were
significant decreases in mean diastolic gradient, PAP, and LA size and
significant improvement in right ventricular tissue Doppler indices after PMBV.
Ac- company these hemodynamic changes after PMBV. P-maximum and P-wave
dispersion were found to be decreased (P < 0.001). Patients developed
cardiac events during follow-up had a higher P-maximum and P-dispersion than
those without late cardiac events (P < 0.001). Moreover the changes in
P-maxi- mum and P-dispersion before and after PMBV in patients with cardiac
events were not significant, while P-maximum and P-dispersion significantly (P
< 0.002) decreased in patients without events It was revealed with linear regression
and correlation analy- sis that the degree of and the changes in P-maximum and
P-wave dispersion were correlated with devel- opment of late cardiac events
after PMBV, with Cut-off values of ≥62.8 msec for P-wave dispersion and
118 mes for P-maximum.ROC curve showed AUC of 0.919 for P-wave dispersion
and 0.913 for P-maximum (P < 0.001). Conclusion: P-wave maximum and dispersion
are significantly increased in patients with mitral stenosis. These changes
decreased significantly after PMBV. The P-maximum and P-wave dispersion changes
were correlated with significant impairment of right dysfunction and the degree
of pulmonary artery pressure. P-maximum and P-wave dispersion could be
considered as independent predictors of late outcome of patients with MS after
successful PMBV (AF, recurrent hospital admission, embolic phenomenon
deterioration of right ventricular function).
Cite this paper
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