Hooman Kamel1, Elsayed Z Soliman2, Susan R Heckbert2, Richard A Kronmal2, W T Longstreth2, Saman Nazarian2, Peter M Okin2. 1. Department of Neurology (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York, NY; Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Departments of Epidemiology (S.R.H., W.T.L.), Biostatistics (R.A.K.), and Neurology (W.T.L.), University of Washington, Seattle; and Division of Cardiology, Johns Hopkins University, Baltimore, MD (S.N.). hok9010@med.cornell.edu. 2. Department of Neurology (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York, NY; Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Departments of Epidemiology (S.R.H., W.T.L.), Biostatistics (R.A.K.), and Neurology (W.T.L.), University of Washington, Seattle; and Division of Cardiology, Johns Hopkins University, Baltimore, MD (S.N.).
Abstract
BACKGROUND AND PURPOSE: Emerging data suggest that left atrial disease may cause ischemic stroke in the absence of atrial fibrillation or flutter (AF). If true, this condition may provide a cause for many strokes currently classified as cryptogenic. METHODS: Among 6741 participants in the Multi-Ethnic Study of Atherosclerosis who were free of clinically apparent cerebrovascular or cardiovascular disease (including AF) at baseline, we examined the association between markers of left atrial abnormality on a standard 12-lead ECG-specifically P-wave area, duration, and terminal force in lead V1-and the subsequent risk of ischemic stroke while accounting for incident AF. RESULTS: During a median follow-up of 8.5 years, 121 participants (1.8%) had a stroke and 541 participants (8.0%) were diagnosed with AF. In Cox proportional hazards models adjusting for potential baseline confounders, P-wave terminal force in lead V1 was more strongly associated with incident stroke (hazard ratio per 1 SD increase, 1.21; 95% confidence interval, 1.02-1.44) than with incident AF (hazard ratio per 1 SD, 1.11; 95% confidence interval, 1.03-1.21). The association between P-wave terminal force in lead V1 and stroke was robust in numerous sensitivity analyses accounting for AF, including analyses that excluded those with any incident AF or modeled any incident AF as having been present from baseline. CONCLUSIONS: We found an association between baseline P-wave morphology and incident stroke even after accounting for AF. This association may reflect an atrial cardiopathy that leads to stroke in the absence of AF.
BACKGROUND AND PURPOSE: Emerging data suggest that left atrial disease may cause ischemic stroke in the absence of atrial fibrillation or flutter (AF). If true, this condition may provide a cause for many strokes currently classified as cryptogenic. METHODS: Among 6741 participants in the Multi-Ethnic Study of Atherosclerosis who were free of clinically apparent cerebrovascular or cardiovascular disease (including AF) at baseline, we examined the association between markers of left atrial abnormality on a standard 12-lead ECG-specifically P-wave area, duration, and terminal force in lead V1-and the subsequent risk of ischemic stroke while accounting for incident AF. RESULTS: During a median follow-up of 8.5 years, 121 participants (1.8%) had a stroke and 541 participants (8.0%) were diagnosed with AF. In Cox proportional hazards models adjusting for potential baseline confounders, P-wave terminal force in lead V1 was more strongly associated with incident stroke (hazard ratio per 1 SD increase, 1.21; 95% confidence interval, 1.02-1.44) than with incident AF (hazard ratio per 1 SD, 1.11; 95% confidence interval, 1.03-1.21). The association between P-wave terminal force in lead V1 and stroke was robust in numerous sensitivity analyses accounting for AF, including analyses that excluded those with any incident AF or modeled any incident AF as having been present from baseline. CONCLUSIONS: We found an association between baseline P-wave morphology and incident stroke even after accounting for AF. This association may reflect an atrial cardiopathy that leads to stroke in the absence of AF.
Authors: E William Hancock; Barbara J Deal; David M Mirvis; Peter Okin; Paul Kligfield; Leonard S Gettes; James J Bailey; Rory Childers; Anton Gorgels; Mark Josephson; Jan A Kors; Peter Macfarlane; Jay W Mason; Olle Pahlm; Pentti M Rautaharju; Borys Surawicz; Gerard van Herpen; Galen S Wagner; Hein Wellens Journal: Circulation Date: 2009-02-19 Impact factor: 29.690
Authors: Shun Kohsaka; Robert R Sciacca; Kenichi Sugioka; Ralph L Sacco; Shunichi Homma; Marco R Di Tullio Journal: Stroke Date: 2005-10-06 Impact factor: 7.914
Authors: Hooman Kamel; Mitchell S V Elkind; Prashant D Bhave; Babak B Navi; Peter M Okin; Costantino Iadecola; Richard B Devereux; Matthew E Fink Journal: Stroke Date: 2013-04-30 Impact factor: 7.914
Authors: Elsayed Z Soliman; Alvaro Alonso; Jeffrey R Misialek; Aditya Jain; Karol E Watson; Donald M Lloyd-Jones; Joao Lima; Steven Shea; Gregory L Burke; Susan R Heckbert Journal: J Electrocardiol Date: 2013-06-24 Impact factor: 1.438
Authors: Paul S Corotto; Hyojung Kang; Brianna Massaro; William C Harding; Neil R Shah; Sneha Gadi; Kenneth Bilchick; Sula Mazimba; Younghoon Kwon Journal: Ann Noninvasive Electrocardiol Date: 2019-02-23 Impact factor: 1.468
Authors: Shadi Yaghi; Yeseon P Moon; Consuelo Mora-McLaughlin; Joshua Z Willey; Ken Cheung; Marco R Di Tullio; Shunichi Homma; Hooman Kamel; Ralph L Sacco; Mitchell S V Elkind Journal: Stroke Date: 2015-04-23 Impact factor: 7.914
Authors: Hooman Kamel; Wesley T O'Neal; Peter M Okin; Laura R Loehr; Alvaro Alonso; Elsayed Z Soliman Journal: Ann Neurol Date: 2015-08-31 Impact factor: 10.422
Authors: Shadi Yaghi; Amelia K Boehme; Rebecca Hazan; Eldad A Hod; Alberto Canaan; Howard F Andrews; Hooman Kamel; Randolph S Marshall; Mitchell S V Elkind Journal: J Stroke Cerebrovasc Dis Date: 2015-10-21 Impact factor: 2.136
Authors: Lin Y Chen; J Thomas Bigger; Kathleen T Hickey; Haiying Chen; Carlos Lopez-Jimenez; Mary Ann Banerji; Gregory Evans; Jerome L Fleg; Vasilios Papademetriou; Abraham Thomas; Vincent Woo; Elizabeth R Seaquist; Elsayed Z Soliman Journal: Am J Hypertens Date: 2016-11-01 Impact factor: 2.689
Authors: Wesley T O'Neal; Muhammad Hammadah; Pratik B Sandesara; Zakaria Almuwaqqat; Ayman Samman-Tahhan; Mohamad M Gafeer; Naser Abdelhadi; Kobina Wilmot; Ibhar Al Mheid; Douglas J Bremner; Michael Kutner; Elsayed Z Soliman; Amit J Shah; Arshed A Quyyumi; Viola Vaccarino Journal: J Cardiovasc Electrophysiol Date: 2017-08-22