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Electrocardiographic Left Atrial Abnormality and Risk of Stroke: Northern Manhattan Study.

TitleElectrocardiographic Left Atrial Abnormality and Risk of Stroke: Northern Manhattan Study.
Publication TypeJournal Article
Year of Publication2015
AuthorsKamel H, Hunter M, Moon YP, Yaghi S, Cheung K, Di Tullio MR, Okin PM, Sacco RL, Soliman EZ, Elkind MSV
JournalStroke
Volume46
Issue11
Pagination3208-12
Date Published2015 Nov
ISSN1524-4628
KeywordsAged, Arrhythmias, Cardiac, Cohort Studies, Electrocardiography, Female, Heart Atria, Humans, Incidence, Intracranial Embolism, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, Prospective Studies, Risk Factors, Stroke
Abstract

BACKGROUND AND PURPOSE: Electrocardiographic left atrial abnormality has been associated with stroke independently of atrial fibrillation (AF), suggesting that atrial thromboembolism may occur in the absence of AF. If true, we would expect an association with cryptogenic or cardioembolic stroke rather than noncardioembolic stroke.

METHODS: We conducted a case-cohort analysis in the Northern Manhattan Study, a prospective cohort study of stroke risk factors. P-wave terminal force in lead V1 was manually measured from baseline ECGs of participants in sinus rhythm who subsequently had ischemic stroke (n=241) and a randomly selected subcohort without stroke (n=798). Weighted Cox proportional hazard models were used to examine the association between P-wave terminal force in lead V1 and stroke etiologic subtypes while adjusting for baseline demographic characteristics, history of AF, heart failure, diabetes mellitus, hypertension, tobacco use, and lipid levels.

RESULTS: Mean P-wave terminal force in lead V1 was 4452 (±3368) μV*ms among stroke cases and 3934 (±2541) μV*ms in the subcohort. P-wave terminal force in lead V1 was associated with ischemic stroke (adjusted hazard ratio per SD, 1.20; 95% confidence interval, 1.03-1.39) and the composite of cryptogenic or cardioembolic stroke (adjusted hazard ratio per SD, 1.31; 95% confidence interval, 1.08-1.58). There was no definite association with noncardioembolic stroke subtypes (adjusted hazard ratio per SD, 1.14; 95% confidence interval, 0.92-1.40). Results were similar after excluding participants with a history of AF at baseline or new AF during follow-up.

CONCLUSIONS: ECG-defined left atrial abnormality was associated with incident cryptogenic or cardioembolic stroke independently of the presence of AF, suggesting atrial thromboembolism may occur without recognized AF.

DOI10.1161/STROKEAHA.115.009989
Alternate JournalStroke
PubMed ID26396031
PubMed Central IDPMC4624510
Grant ListR37 NS029993 / NS / NINDS NIH HHS / United States
K23NS082367 / NS / NINDS NIH HHS / United States
R37NS29993 / NS / NINDS NIH HHS / United States
UL1TR000040 / TR / NCATS NIH HHS / United States
R01 NS029993 / NS / NINDS NIH HHS / United States
UL1 TR000040 / TR / NCATS NIH HHS / United States
K23 NS082367 / NS / NINDS NIH HHS / United States