The Impairment of Left Atrial Volume Index and P-wave Dispersion in Patients with Nasal Septum Deviation

Öz

Aim: This study aimed to investigate the detailed atrial functions and P-wave dispersion in patients with nasal septum deviation (NSD). Material and Methods: The study included patients with NSD (n=40), and a control group with similar age and demographic characteristics but without NSD (n=32). A detailed left atrial (LA) evaluation was performed using two-dimensional transthoracic echocardiography (2D TTE). P-wave dispersion was assessed using electrocardiography. Results: There was no statistically significant difference between the LA diameter, LA area, and LA diameter index of the two groups. Although there was a difference between the two groups in terms of LA area, it did not reach statistical significance (19.3±1.9 vs. 18.7±1.7, p=0.07). A statistically significant difference was found between the two groups in terms of LA volume (43.5±5.8 vs. 41.2±4.7, p=0.04). Left atrial volume index was statistically significantly higher in the NSD group than in the control group (24.1±6.4 vs. 22.3±4.9, p=0.02). P-wave dispersion was statistically significantly higher in the NSD group than in the control group (29.2±8.1 vs. 23.8±8.8, p=0.01). Conclusion: In our study, LA volume, LA volume index and P-wave dispersion were found to be significantly higher in NSD patients compared to the control group. Long-term follow-up studies can be conducted to investigate whether this difference in P-wave dispersion and LA volumes in NSD patients will develop serious arrhythmias such as atrial fibrillation.

Anahtar Kelimeler

• left atrial volume index
• nasal septum deviation
• p wave dispersion

Kaynakça

1. 1. Blum RH, McGowan FX Jr. Chronic upper airway obstruction and cardiac dysfunction: anatomy, pathophysiology and anesthetic implications. Paediatr Anaesth. 2004;14(1):75–83.
2. 2. Alghamdi FS, Albogami D, Alsurayhi AS, Alshibely AY, Alkaabi TH, Alqurashi LM, et al. Nasal Septal Deviation: A Comprehensive Narrative Review. Cureus. 2022;14(11):e31317.
3. 3. Aziz T, Biron VL, Ansari K, Flores-Mir C. Measurement tools for the diagnosis of nasal septal deviation: a systematic review. J Otolaryngol Head Neck Surg. 2014;43(1):11.
4. 4. Celiker M, Cicek Y, Tezi S, Ozgur A, Polat HB, Dursun E. Effect of septoplasty on the heart rate variability in patients with nasal septum deviation. J Craniofac Surg. 2018;29(2):445–8.
5. 5. Anderson RH, Cook AC. The structure and components of the atrial chambers. Europace. 2007;9 Suppl 6: vi3–9.
6. 6. Chen LY, Ribeiro ALP, Platonov PG, Cygankiewicz I, Soliman EZ, Gorenek B, et al. P-wave parameters and indices: a critical appraisal of clinical utility, challenges, and future research-a consensus document endorsed by the international society of electrocardiology and the international society for holter and noninvasive electrocardiology. Circ Arrhythm Electrophysiol. 2022;15(4):e010435.
7. 7. Pérez-Riera AR, de Abreu LC, Barbosa-Barros R, Grindler J, Fernandes-Cardoso A, Baranchuk A. P-wave dispersion: an update. Indian Pacing Electrophysiol J. 2016;16(4):126–133.
8. 8. Dilaveris PE, Gialafos JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol. 2001;6(2):159–65.

9. 9. Perzanowski C, Ho AT, Jacobson AK. Increased P-wave dispersion predicts recurrent atrial f ibrillation after cardioversion. J Electrocardiol. 2005;38(1):43–6.
10. 10. Kelmanson IA. Increased P-wave dispersion in patients with obstructive sleep apnea syndrome: a meta-analysis. Sleep Breath. 2023;27(1):291–301.
11. 11. Küçük U, Mutlu P, Mirici A, Özpınar U, Özpınar SB. Identifying early left atrial dysfunction in COPD patients using ECG morphology-voltage-P-wave duration score. J Electrocardiol. 2025;88:153854.
12. 12. Kraikriangsri C, Khositseth A, Kuptanon T. P-wave dispersion as a simple tool for screening childhood obstructive sleep apnea syndrome. Sleep Med. 2019;54:159–63.
13. 13. Uluyol S, Kilicaslan S, Gur MH, Karakaya NE, Buber I, Ural SG. Effects of nasal septum deviation and septoplasty on cardiac arrhythmia risk. Otolaryngol Head Neck Surg. 2016;155(2):347–52.
14. 14. Wan Q, Xiang G, Xing Y, Hao S, Shu X, Pan C, et al. Left atrial dysfunction in patients with obstructive sleep apnea: a combined assessment by speckle tracking and real-time three-dimensional echocardiography. Ann Palliat Med. 2021;10(3):2668–78.
15. 15. Oliveira W, Campos O, Bezerra Lira-Filho E, Cintra FD, Vieira M, Ponchirolli A, et al. Left atrial volume and function in patients with obstructive sleep apnea assessed by real-time three-dimensional echocardiography. J Am Soc Echocardiogr. 2008;21(12):1355–61.
16. 16. Kellerer C, Kahnert K, Trudzinski FC, Lutter J, Berschneider K, 393 28. Leung RS. Sleep-disordered breathing: autonomic mechanisms Speicher T, et al. COPD maintenance medication is linked to left atrial size: Results from the COSYCONET cohort. Respir Med. 2021;185:106461.
17. 17. Kesgin S, Sereflican M, Yurttas V, Erdem F, Dagli M. The effect of nasal septum deviation on subclinical cardiac autonomic dysfunction. Int J Res Med Sci. 2016;4(4):980–6.
18. 18. Puerta RC, Aliz EL, Lopez-Calleja MA, Ramirez RR, Pena GP. Increased p.wave dispersion in elite athletes. Indian Pacing Electrophysiol J. 2011;11(3):73–80.
19. 19. Chen SC, Su HM, Huang JC, Chang K, Tsai YC, Chen LI, et al. Association of p-wave dispersion with overall and cardiovascular mortality in hemodialysis patients. Am J Nephrol. 2015;42(3):198–205.
20. 20. Bayar N, Çekin AH, Arslan Ş, Çağırcı G, Erkal Z, Çay S, et al. Assessment of left atrial function in patients with celiac disease. Echocardiography. 2015;32(12):1802–8.
21. 21. Irdem A, Aydın Sahin D, Kervancioglu M, Baspinar O, Sucu M, Keskin M, et al. Evaluation of p-wave dispersion, diastolic function, and atrial electromechanical conduction in pediatric patients with subclinical hypothyroidism. Echocardiography. 2016;33(9):1397–401.
22. 22. Ozveren O, Izgi C, Eroglu E, Simsek MA, Turer A, Kucukdurmaz Z, et al. Doppler tissue evaluation of atrial conduction properties in patients with non-alcoholic fatty-liver disease. Ultrason Imaging. 2016;38(3):225–35.
23. 23. Khanna D, Peltzer C, Kahar P, Parmar MS. Body Mass Index (BMI): a screening tool analysis. Cureus. 2022;14(2):e22119.
24. 24. Kahveci OK, Miman MC, Yucel A, Yucedag F, Okur E, Altuntas A. The efficiency of Nose Obstruction Symptom Evaluation (NOSE) scale on patients with nasal septal deviation. Auris Nasus Larynx. 2012;39(3):275–9.
25. 25. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233–70.
26. 26. Burton RF. Estimating body surface area from mass and height: theory and the formula of Du Bois and Du Bois. Ann Hum Biol. 2008;35(2):170–84.
27. 27. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440–63.
28. 28. Leung RS. Sleep-disordered breathing: autonomic mechanisms and arrhythmias. Prog Cardiovasc Dis. 2009;51:324–38.
29. 29. Gozal D, Kheirandish-Gozal L. Cardiovascular morbidity in obstructive sleep apnea: oxidative stress, inflammation, and much more. Am J Respir Crit Care Med. 2008;177:369–75.
30. 30. Li B, Yang H, Lv X, Guo X, Xu F, Li X. Risk assessment and prevention of cardiovascular events in patients with obstructive sleep apnea syndrome: A narrative review. Int J Cardiol Cardiovasc Risk Prev. 2025;26:200455.
31. 31. Kelmanson IA. Increased P-wave dispersion in patients with obstructive sleep apnea syndrome: a meta-analysis. Sleep Breath. 2023;27(1):291–301.
32. 32. Imani MM, Sadeghi M, Khazaie H, Emami M, Sadeghi Bahmani D, Brand S. Evaluation of serum and plasma interleukin-6 levels in obstructive sleep apnea syndrome: a meta-analysis and metaregression. Front Immunol. 2020;11:1343.
33. 33. Mohammadi I, Adibparsa M, Yashooa RK, Sehat MS, Sadeghi M. Effect of continuous positive airway pressure therapy on blood levels of IL-6, IL-10, IL-18, IL-1β, IL-4, and IL-17 in obstructive sleep apnoea adults: A systematic review, meta-analysis and trial sequential analysis. Int Orthod. 2024;22(4):100917.
34. 34. Geng HH, Li R, Su YM, Pan HY, Pan M, Ji XP. A functional single-nucleotide polymorphism in interleukin-6 promoter is associated with p.wave dispersion in hypertensive subjects with atrial fibrillation. Int J Clin Exp Med. 2014;7(11):4434–40.
35. 35. Lazzerini PE, Laghi-Pasini F, Acampa M, Srivastava U, Bertolozzi I, Giabbani B, et al. Systemic ınflammation rapidly ınduces reversible atrial electrical remodeling: the role of ınterleukin-6-mediated changes in connexin expression. J Am Heart Assoc. 2019;8(16):e011006.
36. 36. Caglar O, Aksit E. Evaluation of heart functions with detailed echocardiogram in patients with septum deviation. J Craniofac Surg. 2018;29(8):2148–52.
37. 37. Yigit E, Manav A, Ture M, Karabag T. The impact of septoplasty on cardiopulmonary functions in patients with nasal septal deviation: a prospective comprehensive analysis of echocardiographic outcome and serum n-terminal pro BNP levels. J Craniofac Surg. 2022;33(1):35–40