Title | Electrocardiographic left atrial abnormality and stroke subtype in the atherosclerosis risk in communities study. |
Publication Type | Journal Article |
Year of Publication | 2015 |
Authors | Kamel H, O'Neal WT, Okin PM, Loehr LR, Alonso A |
Secondary Authors | Soliman EZ |
Journal | Ann Neurol |
Volume | 78 |
Issue | 5 |
Pagination | 670-8 |
Date Published | 2015 Nov |
ISSN | 1531-8249 |
Keywords | Atherosclerosis, 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. |
DOI | 10.1002/ana.24482 |
Alternate Journal | Ann Neurol |
PubMed ID | 26179566 |
PubMed Central ID | PMC4624007 |
Grant List | HHSN268201100012C / 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 |