Sex-specific distribution and prognostic significance of p-wave duration in a population-based cohort
M L Benesch Vidal, L Keil, V Link, J Senftinger, J Riess, A Haack, P Clemmensen, R Twerenbold, S Blankenberg, A Ziegler, P M BecherAbstract
Background
P-wave duration (PWD) reflects atrial conduction and structural remodelling and has been linked to atrial fibrillation, sudden cardiac death, and major adverse cardiovascular events (MACE). However, robust population-based data on sex-specific distributions and prognostic implications are lacking.
Purpose
To characterize population-based, sex-specific distributions of PWD and to evaluate their prognostic significance.
Methods
We analysed 16,411 participants aged 45-74 years from the general population with follow-up through May 2023. Individuals in sinus rhythm with available outcome data were included. PWD was categorized as normal (110-120 ms), long (>120 ms), or short (<110 ms) for analysis. The primary endpoint was a composite of MACE or all-cause mortality. Associations with baseline characteristics were quantified using Hodges-Lehmann estimators and modified Wilson-Newcombe confidence intervals. Kaplan–Meier methods were used to estimate the cumulative probability of MACE or all-cause mortality, overall and stratified by sex; associations were evaluated using Cox proportional hazard models.
Results
Of 16,411 participants, 14,112 (49.4% women, median age 60 [interquartile range (IQR) 54-68], 63 [56-70], and 59 [53-67] years with normal, long, and short PWD, respectively) were eligible for analysis. Abnormal PWD was present in 10,720 (75.9%). Median PWD was 115 [IQR 106-124] ms overall, 112 [103-120] ms in women, and 118 [109-128] ms in men. During a median follow-up of 4.3 years [IQR 3.0-5.8], 145 participants with normal, 340 with long, and 195 with short PWD reached the composite endpoint. Compared with normal PWD, short PWD was associated with younger age (−0.97 years, 95% confidence interval (CI) −1.35 to −0.61), lower BMI (−0.55 kg/m², 95% CI −0.74 to −0.35), less often female sex (−10.76%, 95% CI −13.74 to −7.77), and lower systolic blood pressure (−1.5 mmHg, 95% CI −2.5 to −1.0). Long PWD was associated with older age (+2.26 years, 95% CI 1.90 to 2.65), higher body mass index (BMI) (+0.69 kg/m², 95% CI 0.50 to 0.90), higher systolic blood pressure (+3.0 mmHg, 95% CI 2.0 to 3.5), and higher prevalence of hypertension, dyslipidaemia, smoking, coronary artery disease, pacemaker implantation, and asthma (all 95% CIs excluding 0) (Table 1). Cumulative risk analyses revealed that long PWD was associated with increased risk of the composite endpoint in men (HR 1.37, p=0.016) (Figure 1A), whereas short PWD was associated with reduced risk in women (HR 0.70, p=0.030) (Figure 1B).
Conclusion
In this large, community-based cohort, PWD demonstrates marked differences between sex-specific distributions and prognostic relevance. Prolonged PWD identifies men at increased cardiovascular risk, whereas shortened PWD characterises a lower-risk phenotype in women. These findings position PWD as a sex-specific electrocardiographic marker with potential implications for risk stratification in the general population.