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Electrocardiographic left atrial abnormality and stroke subtype in the atherosclerosis risk in communities study.

TitleElectrocardiographic left atrial abnormality and stroke subtype in the atherosclerosis risk in communities study.
Publication TypeJournal Article
Year of Publication2015
AuthorsKamel H, O'Neal WT, Okin PM, Loehr LR, Alonso A
Secondary AuthorsSoliman EZ
JournalAnn Neurol
Volume78
Issue5
Pagination670-8
Date Published2015 Nov
ISSN1531-8249
KeywordsAtherosclerosis, Atrial Function, Left, Brain Ischemia, Cerebral Small Vessel Diseases, Cohort Studies, Electrocardiography, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Prospective Studies, Risk Assessment, Risk Factors, Stroke, Stroke, Lacunar, Thromboembolism
Abstract

OBJECTIVE: The aim of this study was to assess the relationship between abnormally increased P-wave terminal force in lead V1 , an electrocardiographic (ECG) marker of left atrial abnormality, and incident ischemic stroke subtypes. We hypothesized that associations would be stronger with nonlacunar stroke, given that we expected left atrial abnormality to reflect the risk of thromboembolism rather than in situ cerebral small-vessel occlusion.

METHODS: Our cohort comprised 14,542 participants 45 to 64 years of age prospectively enrolled in the Atherosclerosis Risk in Communities study and free of clinically apparent atrial fibrillation (AF) at baseline. Left atrial abnormality was defined as PTFV1 >4,000μV*ms. Outcomes were adjudicated ischemic stroke, nonlacunar (including cardioembolic) ischemic stroke, and lacunar stroke.

RESULTS: During a median follow-up period of 22 years (interquartile range, 19-23 years), 904 participants (6.2%) experienced a definite or probable ischemic stroke. A higher incidence of stroke occurred in those with baseline left atrial abnormality (incidence rate per 1,000 person-years, 6.3; 95% confidence interval [CI]: 5.4-7.4) than in those without (incidence rate per 1,000 person-years, 2.9; 95% CI: 2.7-3.1; p

INTERPRETATION: We found an association between ECG-defined left atrial abnormality and subsequent nonlacunar ischemic stroke. Our findings suggest that an underlying atrial cardiopathy may cause left atrial thromboembolism in the absence of recognized AF.

DOI10.1002/ana.24482
Alternate JournalAnn Neurol
PubMed ID26179566
PubMed Central IDPMC4624007
Grant ListHHSN268201100012C / HL / NHLBI NIH HHS / United States
HHSN268201100009I / HL / NHLBI NIH HHS / United States
HHSN268201100010C / HL / NHLBI NIH HHS / United States
HHSN268201100008C / HL / NHLBI NIH HHS / United States
HHSN268201100005G / HL / NHLBI NIH HHS / United States
HHSN268201100008I / HL / NHLBI NIH HHS / United States
HHSN268201100007C / HL / NHLBI NIH HHS / United States
HHSN268201100011I / HL / NHLBI NIH HHS / United States
HHSN268201100011C / HL / NHLBI NIH HHS / United States
K23NS082367 / NS / NINDS NIH HHS / United States
HHSN268201100006C / HL / NHLBI NIH HHS / United States
HHSN268201100005I / HL / NHLBI NIH HHS / United States
HHSN268201100009C / HL / NHLBI NIH HHS / United States
HHSN268201100005C / HL / NHLBI NIH HHS / United States
HHSN268201100007I / HL / NHLBI NIH HHS / United States
K23 NS082367 / NS / NINDS NIH HHS / United States