The predictive value of abnormal P-wave frontal electrical axis for death risk of different diseases

doi:10.3877/cma.j.issn.2095-6568.2023.01.003

Abstract

Abstract:

Objective

To investigate the association between abnormal P-wave frontal axis in electrocardiogram (ECG) and the risk of death from various diseases.

Methods

The study enrolled adults who had sinus rhythm at the time of ECG examination in the Third American Health and Nutrition Survey (from January,1988 to December,1994) and excluded those with missing survival data. An abnormal P-wave frontal axis was defined as any value other than 0° to 75°. The primary outcome was death from all causes as defined by ICD-9. The abnormal P-wave axis was included as an exposure variable into the multivariate Cox regression model to evaluate the relationship with the risk of all-cause mortality. The competitive risk model was used to explore the relationship with the risk of death from different diseases.

Results

A total of 8 220 participants with average age of (60.10±13.50) years were included in this study, 52% of the participants were female and 73.3% were white. The median follow-up was 259[131,328] months and there were 5 169 deaths. After multivariate adjustment, the frontal axis of P wave was found to be nonlinearly related to the risk of all-cause mortality, and the lowest risk point was 50°. Abnormal P-wave frontal axis was associated with an increased risk of all-cause mortality. In the multivariate adjusted competitive risk model, abnormal P-wave frontal axis was mainly associated with a one-fold increased risk of death from chronic lung disease.

Conclusion

The frontal axis of P wave is repeatable and non-invasive measurement that can predict the risk of death. Abnormal P-wave frontal axis is associated with an increased risk of death, particularly from chronic lung disease. Therefore, screening for lung diseases should be focused on people with abnormal frontal P-wave axis.

Key words: Electrocardiography, P-wave frontal electrical axis, All-cause mortality, Chronic lung disease

Xiaodi Cao, Zhe Wang. The predictive value of abnormal P-wave frontal electrical axis for death risk of different diseases[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2023, 11(01): 12-17.

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Figures/Tables 3

变量	P波额面电轴正常组	P波额面电轴异常组	P值
例数	6 305	1915
年龄（岁）	59.46±13.39	62.21±13.65	<0.001
体重指数（kg/m²）	28.42±5.31	24.92±5.08	<0.001
女［例（%）］	3260（51.7）	1 016（53.1）	0.313
种族［例（%）］			0.002
非西班牙裔白人	4 676（74.2）	1 349（70.4）
非西班牙裔黑人	1 451（23.0）	515（26.9）
其他种族	178（2.8）	51（2.7）
婚姻状况［例（%）］			<0.001
已婚	4 107（65.3）	1 142（59.7）
离婚/丧偶	1 718（27.3）	639（33.4）
未婚	467（7.4）	132（6.9）
收入/年［例（%）］			0.094
≥20 000美元	3 256（52.5）	943（50.3）
<20 000美元	2 942（47.5）	932（49.7）
吸烟［例（%）］			<0.001
从不吸烟	2 965（47.0）	715（37.3）
现已戒烟	2 108（33.4）	582（30.4）
现在吸烟	1 232（19.5）	618（32.3）
既往病史［例（%）］
心肌梗死	444（7.1）	124（6.5）	0.410
卒中	246（3.9）	93（4.9）	0.076
心力衰竭	320（5.1）	93（4.9）	0.745
糖尿病	805（12.8）	174（9.1）	<0.001
高血压	2 022（32.2）	465（24.4）	<0.001
肿瘤	681（10.8）	244（12.7）	0.021
肺部疾病	714（11.3）	390（79.6）	<0.001
心电图指标
P波额面电轴（^°， $x ¯ ± s$ ）	53.19±16.88	75.89±29.62	<0.001
心肌梗死损伤评分（分， $x ¯ ± s$ ）	66.57±84.13	76.15±86.50	<0.001
心电图诊断的左心室肥厚［例（%）］^a	659（10.5）	154（8.0）	0.002
Ⅱ导联P波振幅［μV， $x ¯ ± s$ ］	124.52±46.22	161.54±65.22	<0.001
V₁导联P波负向波振幅［μV，M（Q₁，Q₂）］	-38.00（-56.00，-23.00）	-37.00（-58.00，-21.00）	0.935

变量	P波额面电轴正常组	P波额面电轴异常组	P值
例数	6 305	1915
年龄（岁）	59.46±13.39	62.21±13.65	<0.001
体重指数（kg/m²）	28.42±5.31	24.92±5.08	<0.001
女［例（%）］	3260（51.7）	1 016（53.1）	0.313
种族［例（%）］			0.002
非西班牙裔白人	4 676（74.2）	1 349（70.4）
非西班牙裔黑人	1 451（23.0）	515（26.9）
其他种族	178（2.8）	51（2.7）
婚姻状况［例（%）］			<0.001
已婚	4 107（65.3）	1 142（59.7）
离婚/丧偶	1 718（27.3）	639（33.4）
未婚	467（7.4）	132（6.9）
收入/年［例（%）］			0.094
≥20 000美元	3 256（52.5）	943（50.3）
<20 000美元	2 942（47.5）	932（49.7）
吸烟［例（%）］			<0.001
从不吸烟	2 965（47.0）	715（37.3）
现已戒烟	2 108（33.4）	582（30.4）
现在吸烟	1 232（19.5）	618（32.3）
既往病史［例（%）］
心肌梗死	444（7.1）	124（6.5）	0.410
卒中	246（3.9）	93（4.9）	0.076
心力衰竭	320（5.1）	93（4.9）	0.745
糖尿病	805（12.8）	174（9.1）	<0.001
高血压	2 022（32.2）	465（24.4）	<0.001
肿瘤	681（10.8）	244（12.7）	0.021
肺部疾病	714（11.3）	390（79.6）	<0.001
心电图指标
P波额面电轴（^°， $x ¯ ± s$ ）	53.19±16.88	75.89±29.62	<0.001
心肌梗死损伤评分（分， $x ¯ ± s$ ）	66.57±84.13	76.15±86.50	<0.001
心电图诊断的左心室肥厚［例（%）］^a	659（10.5）	154（8.0）	0.002
Ⅱ导联P波振幅［μV， $x ¯ ± s$ ］	124.52±46.22	161.54±65.22	<0.001
V₁导联P波负向波振幅［μV，M（Q₁，Q₂）］	-38.00（-56.00，-23.00）	-37.00（-58.00，-21.00）	0.935

结局	未校正HR（95% CI）	P值	校正后HR（95% CI）^a	P值
全因死亡	1.37（1.29~1.45）	<0.001	1.31（1.21~1.41）	<0.001
心脏疾病	1.05（0.93~1.18）	0.430	0.94（0.82~1.09）	0.420
恶性肿瘤	1.20（1.06~1.37）	0.003	0.99（0.85~1.15）	0.890
慢性肺部疾病	3.35（2.61~4.29）	<0.001	1.99（1.51~2.63）	<0.001
事故（意外伤害）	1.09（0.72~1.68）	0.670	0.95（0.57~1.56）	0.830
脑血管疾病	1.32（1.05~1.67）	0.017	1.05（0.81~1.37）	0.700
阿尔茨海默病	1.18（0.83~1.67）	0.350	0.91（0.62~1.32）	0.620
糖尿病	0.91（0.65~1.29）	0.610	1.33（0.91~1.94）	0.140
流感和肺炎	1.42（1.00~2.01）	0.050	1.06（0.72~1.56）	0.770
肾脏疾病	0.82（0.48~1.40）	0.470	0.66（0.37~1.20）	0.170
其他死因	1.07（0.93~1.22）	0.350	1.30（1.12~1.51）	<0.001

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