Usefulness of P‐wave peak time as an electrocardiographic parameter in predicting left ventricular diastolic dysfunction in patients with mitral regurgitation

INTRODUCTION: Conventional Doppler measurements have limitations in predicting left ventricular diastolic dysfunction (LVDD) in patients with mitral regurgitation (MR). Recently, electrocardiographic P‐wave peak time (PWPT) has been proposed as a parameter of detecting LVDD. This study aimed to evaluate the association between PWPT and left ventricular end‐diastolic pressure (LVEDP) in patients with MR. METHODS: We performed echocardiography and cardiac catheterization in 82 patients with moderate or severe MR. We classified patients into two groups: low LVEDP group (L‐LVEDP) (LVEDP <16 mmHg, n = 40) and high LVEDP group (H‐LVEDP) (LVEDP ≥16 mmHg, n = 42). We evaluated LVDD and PWPT based on echocardiographic and electrocardiographic findings in both groups. RESULTS: The PWPT in lead II (PWPT(II)) was significantly longer in patients in the H‐LVEDP group than in those in the L‐LVEDP group (67 vs. 47 ms, p < .001). Using correlation analysis, LVEDP was positively correlated with PWPT(II) (r = .577, p < .001). Using multivariate analysis, PWPT(II) was found to be an independent predictor of increased LVEDP (95% CI: 0.1030–0.110; p < .001). Using receiver operating characteristic (ROC) curve analysis, the optimal cutoff value of PWPT(II) for predicting elevated LVEDP was 58.9 ms, with a sensitivity of 80.0% and a specificity of 73.8% (area under curve: 0.809, 95% CI: 0.713–0.905). CONCLUSION: To the best of our knowledge, this is the first study to assess the effect of a significant valvular disease on PWPT in lead II. These findings suggest that prolonged PWPT(II) may be an independent predictor of increased LVEDP in patients with moderate or severe MR.