Jared W Magnani1, Lei Zhu2, Faye Lopez3, Michael J Pencina4, Sunil K Agarwal5, Elsayed Z Soliman6, Emelia J Benjamin7, Alvaro Alonso3. 1. Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, MA; National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, MA. Electronic address: jmagnani@bu.edu. 2. Department of Mathematics and Statistics, Boston University, Boston, MA. 3. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN. 4. National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, MA; Duke Clinical Research Institute, Duke University, Durham, NC; Department of Mathematics and Statistics, Boston University, Boston, MA; Department of Biostatistics, Boston University School of Public Health, Boston, MA. 5. Johns Hopkins University, Baltimore, MD. 6. Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC. 7. Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, MA; National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA.
Abstract
BACKGROUND: Atrial fibrillation (AF) is associated with increased morbidity. P-wave indices (PWIs) measure atrial electrical function and are associated with AF. Study of PWI has been limited to single-cohort investigations, and their contributions to risk enhancement are unknown. METHODS: We examined PWI from the FHS and ARIC study. We calculated 10-year AF risk using adjusted Cox models. We conducted cross-cohort meta-analyses for the PWI estimates and assessed their contributions to risk discrimination (c statistic), net reclassification index, and integrated discrimination improvement. RESULTS: After exclusions, the analysis included 3,110 FHS (62.6 ± 9.8 years, 56.9% women) and 8,254 ARIC participants (62.3 ± 5.6 years, 57.3% women, 20.3% black race). Over 10 years, 217 FHS and 458 ARIC participants developed AF. In meta-analysis, P-wave duration >120 milliseconds was significantly associated with AF (hazard ratio 1.55, 95% CI 1.29-1.85) compared with ≤120 milliseconds. P-wave area was marginally but not significantly related to AF (hazard ratio 1.31, 95% CI 0.95-1.80). P-wave terminal force was strongly associated with AF in ARIC but not FHS. P-wave indices had a limited contribution toward predictive risk beyond traditional risk factors and markers. CONCLUSIONS: P-wave indices are intermediate phenotypes for AF. They are associated with AF in cross-cohort meta-analyses but contribute minimally toward enhancing risk prediction.
BACKGROUND:Atrial fibrillation (AF) is associated with increased morbidity. P-wave indices (PWIs) measure atrial electrical function and are associated with AF. Study of PWI has been limited to single-cohort investigations, and their contributions to risk enhancement are unknown. METHODS: We examined PWI from the FHS and ARIC study. We calculated 10-year AF risk using adjusted Cox models. We conducted cross-cohort meta-analyses for the PWI estimates and assessed their contributions to risk discrimination (c statistic), net reclassification index, and integrated discrimination improvement. RESULTS: After exclusions, the analysis included 3,110 FHS (62.6 ± 9.8 years, 56.9% women) and 8,254 ARIC participants (62.3 ± 5.6 years, 57.3% women, 20.3% black race). Over 10 years, 217 FHS and 458 ARIC participants developed AF. In meta-analysis, P-wave duration >120 milliseconds was significantly associated with AF (hazard ratio 1.55, 95% CI 1.29-1.85) compared with ≤120 milliseconds. P-wave area was marginally but not significantly related to AF (hazard ratio 1.31, 95% CI 0.95-1.80). P-wave terminal force was strongly associated with AF in ARIC but not FHS. P-wave indices had a limited contribution toward predictive risk beyond traditional risk factors and markers. CONCLUSIONS: P-wave indices are intermediate phenotypes for AF. They are associated with AF in cross-cohort meta-analyses but contribute minimally toward enhancing risk prediction.
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