Hooman Kamel1, Traci M Bartz2, W T Longstreth2, Peter M Okin2, Evan L Thacker2, Kristen K Patton2, Phyllis K Stein2, Rebecca F Gottesman2, Susan R Heckbert2, Richard A Kronmal2, Mitchell S V Elkind2, Elsayed Z Soliman2. 1. From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.). hok9010@med.cornell.edu. 2. From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
Abstract
BACKGROUND AND PURPOSE: Emerging evidence suggests that atrial disease is associated with vascular brain injury in the absence of atrial fibrillation. METHODS: The Cardiovascular Health Study prospectively enrolled community-dwelling adults aged ≥65 years. Among participants who underwent MRI, we examined associations of ECG left atrial abnormality with brain infarcts and leukoaraiosis. P-wave terminal force in lead V1 was the primary measure of left atrial abnormality; P-wave area and duration were secondary predictors. We excluded participants with atrial fibrillation before or on their index ECG. Primary outcomes were incident infarcts and worsening leukoaraiosis from initial to follow-up scan ≈5 years later. Secondary outcomes were prevalent infarcts and degree of leukoaraiosis on initial MRI. Relative risk (RR) and linear regression models were adjusted for vascular risk factors. RESULTS: Among 3129 participants with ≥1 scan, each SD increase in P-wave terminal force in lead V1 was associated with a 0.05-point (95% confidence interval [CI], 0.0003-0.10) higher baseline white matter grade on a 10-point scale. P-wave terminal force in lead V1 was associated with prevalent infarcts of any type (RR per SD, 1.09; 95% CI, 1.04-1.16) and more so with prevalent nonlacunar infarcts (RR per SD, 1.22; 95% CI, 1.08-1.38). Among 1839 participants with 2 scans, P-wave terminal force in lead V1 was associated with worsening leukoaraiosis (RR per SD, 1.09; 95% CI, 1.01-1.18), but not with incident infarcts (RR per SD, 1.06; 95% CI, 0.93-1.20). Sensitivity analyses adjusting for incident atrial fibrillation found similar results. P-wave area and duration were not associated with outcomes. CONCLUSIONS: ECG left atrial abnormality is associated with vascular brain injury in the absence of documented atrial fibrillation.
BACKGROUND AND PURPOSE: Emerging evidence suggests that atrial disease is associated with vascular brain injury in the absence of atrial fibrillation. METHODS: The Cardiovascular Health Study prospectively enrolled community-dwelling adults aged ≥65 years. Among participants who underwent MRI, we examined associations of ECG left atrial abnormality with brain infarcts and leukoaraiosis. P-wave terminal force in lead V1 was the primary measure of left atrial abnormality; P-wave area and duration were secondary predictors. We excluded participants with atrial fibrillation before or on their index ECG. Primary outcomes were incident infarcts and worsening leukoaraiosis from initial to follow-up scan ≈5 years later. Secondary outcomes were prevalent infarcts and degree of leukoaraiosis on initial MRI. Relative risk (RR) and linear regression models were adjusted for vascular risk factors. RESULTS: Among 3129 participants with ≥1 scan, each SD increase in P-wave terminal force in lead V1 was associated with a 0.05-point (95% confidence interval [CI], 0.0003-0.10) higher baseline white matter grade on a 10-point scale. P-wave terminal force in lead V1 was associated with prevalent infarcts of any type (RR per SD, 1.09; 95% CI, 1.04-1.16) and more so with prevalent nonlacunar infarcts (RR per SD, 1.22; 95% CI, 1.08-1.38). Among 1839 participants with 2 scans, P-wave terminal force in lead V1 was associated with worsening leukoaraiosis (RR per SD, 1.09; 95% CI, 1.01-1.18), but not with incident infarcts (RR per SD, 1.06; 95% CI, 0.93-1.20). Sensitivity analyses adjusting for incident atrial fibrillation found similar results. P-wave area and duration were not associated with outcomes. CONCLUSIONS: ECG left atrial abnormality is associated with vascular brain injury in the absence of documented atrial fibrillation.
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: J Am Coll Cardiol Date: 2009-03-17 Impact factor: 24.094
Authors: Jonathan P Piccini; Bradley G Hammill; Moritz F Sinner; Paul N Jensen; Adrian F Hernandez; Susan R Heckbert; Emelia J Benjamin; Lesley H Curtis Journal: Circ Cardiovasc Qual Outcomes Date: 2012-01-10
Authors: Kristen K Patton; Patrick T Ellinor; Susan R Heckbert; Robert H Christenson; Christopher DeFilippi; John S Gottdiener; Richard A Kronmal Journal: Circulation Date: 2009-10-19 Impact factor: 29.690
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: Robert G Hart; Hans-Christoph Diener; Shelagh B Coutts; J Donald Easton; Christopher B Granger; Martin J O'Donnell; Ralph L Sacco; Stuart J Connolly Journal: Lancet Neurol Date: 2014-04 Impact factor: 44.182
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: 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: 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: Hooman Kamel; Madeleine Hunter; Yeseon P Moon; Shadi Yaghi; Ken Cheung; Marco R Di Tullio; Peter M Okin; Ralph L Sacco; Elsayed Z Soliman; Mitchell S V Elkind Journal: Stroke Date: 2015-09-22 Impact factor: 7.914
Authors: Hooman Kamel; Traci M Bartz; Mitchell S V Elkind; Peter M Okin; Evan L Thacker; Kristen K Patton; Phyllis K Stein; Christopher R deFilippi; Rebecca F Gottesman; Susan R Heckbert; Richard A Kronmal; Elsayed Z Soliman; W T Longstreth Journal: Stroke Date: 2018-03-13 Impact factor: 7.914
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
Authors: Wesley T O'Neal; Hooman Kamel; Dawn Kleindorfer; Suzanne E Judd; George Howard; Virginia J Howard; Elsayed Z Soliman Journal: Neuroepidemiology Date: 2016-08-17 Impact factor: 3.282
Authors: Jeffrey J Goldberger; Rishi Arora; David Green; Philip Greenland; Daniel C Lee; Donald M Lloyd-Jones; Michael Markl; Jason Ng; Sanjiv J Shah Journal: Circulation Date: 2015-07-28 Impact factor: 29.690