‘P’ MITRALE AND LEFT ATRIAL ENLARGEMENT: COMPARISON WITH ECHOCARDIOGRAPHY

Abstract

Background: This study was carried out to determine the sensitivity and specificity of ‘P’ Mitrale in diagnosing left atrial enlargement by comparing it with the Gold Standard of echocardiography. Methods: The study was carried out at the department of Physiology, Army Medical College, Rawalpindi and department of Cardiology at Armed Forces Institute of Cardiology / National Institute of Heart Diseases. 50 clinically diagnosed cases of left atrial enlargement were included in the study. ECG of the patients was recorded and ‘P’ Mitrale observed. This was followed by echocardiography and using 2-D echocardiogram as a guideline M-mode recording was obtained and left atrial size was calculated. Results: ‘P’ Mitrale has a sensitivity of 22.5% and specificity of 100%. The positive and negative predictive value and diagnostic efficacy of the test were also calculated. Conclusion: Sensitivity of ECG is low in detecting left atrial enlargement. However its sensitivity can be increased by combining ‘P’ Terminal Force in lead V₁ and P/P-R ratio to ‘P’ Mitrale. ECG is however still recommended as a routine investigation because of its cost effectiveness and easy availability.