Association of P‐Wave Parameters With Left Atrial Hemodynamics in Atrial Cardiomyopathy

BACKGROUND: P-wave parameters, readily obtainable from standard 12-lead ECGs, have been associated with atrial fibrillation (AF), ischemic stroke, and other cardiovascular conditions. Left atrial cardiomyopathy (AtCM), characterized by atrial fibrosis and functional impairment, is considered a central substrate in the development of AF and embolic stroke of undetermined source. This study examines the relationship between P-wave parameters and left atrial hemodynamics and evaluates their potential diagnostic utility in identifying AtCM. METHODS: We conducted a monocentric, prospective study in hospitalized patients. Inclusion criteria were sinus rhythm and age ≥ 18 years. P-wave parameters were assessed in conjunction with echocardiographic measures of left atrial function. Statistical analyses compared patients with and without pathological P-wave parameters. RESULTS: A total of 416 patients were included. Pathological P-wave parameters were highly prevalent, with 55% of patients exhibiting ≥ 3 abnormalities. Advanced interatrial block (IAB) showed a robust association with impaired left atrial hemodynamics, whereas other parameters, such as PTFV1, demonstrated only weak correlations. Patients with advanced IAB exhibited significant alterations in left atrial size, function, and NT-proBNP levels. CONCLUSIONS: Advanced IAB emerged as the most reliable P-wave parameter for detecting left atrial dysfunction in AtCM, whereas other P-wave indices, including PTFV1, were less informative. These findings highlight the diagnostic value of advanced IAB in identifying AtCM, particularly in patients with embolic stroke of undetermined source, and emphasize the need for more refined diagnostic criteria in future investigations.