CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 2, March/April 2011
78
AFRICA
ventricular diastolic dysfunction. Left ventricular hypertrophy,
cardiomyopathy, myocardial ischaemia, systemic hypertension
and normal aging are recognised causes. In diastolic dysfunc-
tion, rapid early filling is decreased, pressure upstream of the
left ventricle is increased and atrial systole therefore has a crucial
role to play to decrease atrial pressure and resume left ventricular
filling.
P-wave dispersion has been described as a non-invasive indi-
cator of risk of atrial fibrillation.
1
If atrial fibrillation occurs, the
loss of atrial systolic contribution to the left ventricular diastolic
filling results in progressive diastolic dysfunction. Increased
P-wave dispersion has been noted in hypertensive patients with
diastolic dysfunction when compared with patients without dias-
tolic dysfunction.
10
Although some studies have suggested that
left atrial diameter is an important predictor of atrial fibrillation,
and that P-wave duration is related to left atrial dimension, the
present study did not observe any relationship between P-wave
dispersion and left atrial dimension.
11,12
P-wave dispersion in sickle cell anaemia positively correlated
with patients’ age (duration of illness), suggesting a progres-
sive deterioration with time. Ayetemir and associates,
13
in an
investigation of clinical variables that affect P-wave dispersion
in normal subjects, identified age as a related variable. However,
in this study, no such correlation was observed in the control
subjects. The authors are not aware of any previous study on
P-wave dispersion in sickle cell anaemia. In view of the fact that
diastolic dysfunction is a common cardiac complication of sickle
cell anaemia, this study could be considered as an initial evalu-
ation of the usefulness of this simple, non-invasive diagnostic
tool in the assessment of diastolic function in sickle cell anaemia
patients.
Conclusion
P-wave dispersion was increased in patients with sickle cell
anaemia and significantly correlated positively with age and
negatively with left ventricular diastolic function. These findings
suggest that P-wave dispersion could be useful in the evaluation
of sickle cell patients with left ventricular diastolic dysfunction.
However, further prospective studies are recommended to evalu-
ate its prognostic implication on the long-term disease outcome
in sickle cell disease patients.
We thank Mrs Dora Okorogu of the Cardiac Centre, University of Nigeria
Teaching Hospital, Ituku-Ozalla, Enugu for offering technical support in
electrocardiographic recording.
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