Correlation of Electrocardiography with Echocardiography in the Assessment of Left Atrial Overload

Background and objectives: Left atrial overload parameters in the electrocardiogram could suggest rising left atrial pressure that leads to heart disease. An increase in the Left atrial area and pressure are signs of left ventricle diastolic dysfunction. Therefore, we aimed to find the relationship between electrocardiogram and left ventricle diastolic function by echocardiography to assess left atrial overload. Methods: This observational, cross-sectional study enrolled 200 patients with cardiac symptom(s) from April 2024 to April 2025 at Sulaimani Cardiac Hospital and Faruk Medical City, using a convenient sampling method. The patients underwent electrocardiography and echocardiography. Later, the correlations between both techniques were determined in relation to left atrium overload in diastolic dysfunction. Results: Among studied patients, 51.5% had hypertension, 32.5% had diabetes, 19% had ischemic heart disease, 57.5% presented with shortness of breath, 38% with chest pain, 25.5%, with palpitation, 1.5% had aortic stenosis, 2.0% had aortic regurgitation, and 41% had diastolic dysfunction. Echocardiography showed that tricuspid regurgitation velocity and heart rate did not differ among the grades of diastolic dysfunction. P-duration exhibited a decent correlation with left atrial volume index (p<0.001), while P terminal force in V1 showed rational correlations with left atrial volume index and E/é (p<0.001). P-duration and P terminal force in V1 significantly correlated among left ventricle diastolic function grades (p<0.001). Conclusions: P-duration and P terminal force in V1 could indicate left atrial overload if electrocardiography and echocardiography are used to correlate grades of diastolic dysfunction.