ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Predictive Value of Electrocardiogram Morphology-Voltage-P Wave Duration Score for New Episodes of Atrial Fibrillation in Patients with Acute Myocardial Infarction: A Retrospective Study
Provisionally accepted
- Second Affiliated Hospital of Jilin University, Changchun, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: The prevalence of atrial fibrillation (AF) is approximately 1.5-2% of the general population. The Morphology-Voltage-P Wave Duration (MVP) score, a novel electrocardiographic tool based on P-wave characteristics, has shown promise in predicting AF risk. New-onset atrial fibrillation (NOAF) following acute myocardial infarction (AMI) is associated with poor clinical outcomes. Methods: This retrospective study included 334 patients treated for AMI from January 2018 to April 2021. Patients were categorized into low-risk (202 cases), medium-risk (98 cases), and high-risk (34 cases) groups based on MVP ECG scores. NOAF incidence, stratified as early-onset (≤48 hours) and late-onset (>48 hours), was tracked over a 12-month follow-up period. Statistical analyses included group comparisons, Cox regression for multivariate adjustment, ROC analysis to evaluate and compare the predictive performance of the MVP score against both the CHA₂DS₂-VASc and the AF-specific C2HEST scores, and decision curve analysis (DCA) to assess clinical utility. Results: The MVP ECG risk score effectively predicted long-term AF incidence, showing a graded increase in risk across categories: 11.9% in low-risk, 28.6% in medium-risk, and 76.5% in high-risk patients. Incidence increased for both early-onset (4.0%, 10.2%, 29.4%) and late-onset NOAF (7.9%, 18.4%, 47.1%). The MVP score demonstrated superior discriminative ability for total NOAF (AUC = 0.908) compared to the CHA₂DS₂-VASc score (AUC = 0.643) and the C2HEST score (AUC = 0.715), with the highest performance observed for late-onset NOAF (AUC = 0.925). Addition of the MVP score to either clinical score significantly improved reclassification (NRI: 0.28–0.35, IDI: 0.07–0.08). DCA confirmed that using the MVP score provided a greater net clinical benefit than the comparator scores across realistic decision thresholds. Multivariate analysis confirmed the MVP score as an independent predictor of AF, with a stronger association for late-onset events. Conclusion: The MVP ECG risk score is a simple, non-invasive tool that provides superior prediction of NOAF in AMI patients compared to traditional clinical risk scores, exhibiting particular strength in identifying patients at risk for late-onset AF. It effectively identifies high-risk patients who may benefit from close monitoring and proactive management strategies.
Keywords: acute myocardial infarction, Long-term prognosis, MVP ECG score, New-onset atrial fibrillation, risk prediction, Riskstratification
Received: 28 Sep 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 Li, Liu, Lu and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bin Liu
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.