Ankit Maheshwari1, Faye L Norby2, Elsayed Z Soliman2, Ryan J Koene2, Mary R Rooney2, Wesley T O'Neal2, Alvaro Alonso2, Lin Y Chen2. 1. Cardiovascular Division, Department of Medicine (A.M., R.K., L.Y.C.) and Division of Epidemiology and Community Health, School of Public Health (F.L.N., M.R.R.), University of Minnesota, Minneapolis; Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (W.T.O.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.). mahes046@umn.edu. 2. Cardiovascular Division, Department of Medicine (A.M., R.K., L.Y.C.) and Division of Epidemiology and Community Health, School of Public Health (F.L.N., M.R.R.), University of Minnesota, Minneapolis; Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston-Salem, NC (E.Z.S.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (W.T.O.); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA (A.A.).
Abstract
BACKGROUND AND PURPOSE: Abnormal P-wave axis (aPWA) has been linked to incident atrial fibrillation and mortality; however, the relationship between aPWA and stroke has not been reported. We hypothesized that aPWA is associated with ischemic stroke independent of atrial fibrillation and other stroke risk factors and tested our hypothesis in the ARIC study (Atherosclerosis Risk In Communities), a community-based prospective cohort study. METHODS: We included 15 102 participants (aged 54.2±5.7 years; 55.2% women; 26.5% blacks) who attended the baseline examination (1987-1989) and without prevalent stroke. We defined aPWA as any value outside 0 to 75° using 12-lead ECGs obtained during study visits. Each case of incident ischemic stroke was classified in accordance with criteria from the National Survey of Stroke by a computer algorithm and adjudicated by physician review. Multivariable Cox regression was used to estimate hazard ratios and 95% confidence intervals for the association of aPWA with stroke. RESULTS: During a mean follow-up of 20.2 years, there were 657 incident ischemic stroke cases. aPWA was independently associated with a 1.50-fold (95% confidence interval, 1.22-1.85) increased risk of ischemic stroke in the multivariable model that included atrial fibrillation. When subtyped, aPWA was associated with a 2.04-fold (95% confidence interval, 1.42-2.95) increased risk of cardioembolic stroke and a 1.32-fold (95% confidence interval, 1.03-1.71) increased risk of thrombotic stroke. CONCLUSIONS: aPWA is independently associated with ischemic stroke. This association seems to be stronger for cardioembolic strokes. Collectively, our findings suggest that alterations in atrial electric activation may predispose to cardiac thromboembolism independent of atrial fibrillation.
BACKGROUND AND PURPOSE:Abnormal P-wave axis (aPWA) has been linked to incident atrial fibrillation and mortality; however, the relationship between aPWA and stroke has not been reported. We hypothesized that aPWA is associated with ischemic stroke independent of atrial fibrillation and other stroke risk factors and tested our hypothesis in the ARIC study (Atherosclerosis Risk In Communities), a community-based prospective cohort study. METHODS: We included 15 102 participants (aged 54.2±5.7 years; 55.2% women; 26.5% blacks) who attended the baseline examination (1987-1989) and without prevalent stroke. We defined aPWA as any value outside 0 to 75° using 12-lead ECGs obtained during study visits. Each case of incident ischemic stroke was classified in accordance with criteria from the National Survey of Stroke by a computer algorithm and adjudicated by physician review. Multivariable Cox regression was used to estimate hazard ratios and 95% confidence intervals for the association of aPWA with stroke. RESULTS: During a mean follow-up of 20.2 years, there were 657 incident ischemic stroke cases. aPWA was independently associated with a 1.50-fold (95% confidence interval, 1.22-1.85) increased risk of ischemic stroke in the multivariable model that included atrial fibrillation. When subtyped, aPWA was associated with a 2.04-fold (95% confidence interval, 1.42-2.95) increased risk of cardioembolic stroke and a 1.32-fold (95% confidence interval, 1.03-1.71) increased risk of thrombotic stroke. CONCLUSIONS: aPWA is independently associated with ischemic stroke. This association seems to be stronger for cardioembolic strokes. Collectively, our findings suggest that alterations in atrial electric activation may predispose to cardiac thromboembolism independent of atrial fibrillation.
Authors: Hemantha Koduri; Jason Ng; Ivan Cokic; Gary L Aistrup; David Gordon; J Andrew Wasserstrom; Alan H Kadish; Richard Lee; Rod Passman; Bradley P Knight; Jeffrey J Goldberger; Rishi Arora Journal: Circ Arrhythm Electrophysiol Date: 2012-06-21
Authors: Yoko Miyasaka; Marion E Barnes; Bernard J Gersh; Stephen S Cha; Kent R Bailey; Walter P Abhayaratna; James B Seward; Teresa S M Tsang Journal: Circulation Date: 2006-07-03 Impact factor: 29.690
Authors: W D Rosamond; A R Folsom; L E Chambless; C H Wang; P G McGovern; G Howard; L S Copper; E Shahar Journal: Stroke Date: 1999-04 Impact factor: 7.914
Authors: B M Psaty; T A Manolio; L H Kuller; R A Kronmal; M Cushman; L P Fried; R White; C D Furberg; P M Rautaharju Journal: Circulation Date: 1997-10-07 Impact factor: 29.690
Authors: Alvaro Alonso; Sunil K Agarwal; Elsayed Z Soliman; Marietta Ambrose; Alanna M Chamberlain; Ronald J Prineas; Aaron R Folsom Journal: Am Heart J Date: 2009-07 Impact factor: 4.749
Authors: Chiadi E Ndumele; Kunihiro Matsushita; Mariana Lazo; Natalie Bello; Roger S Blumenthal; Gary Gerstenblith; Vijay Nambi; Christie M Ballantyne; Scott D Solomon; Elizabeth Selvin; Aaron R Folsom; Josef Coresh Journal: J Am Heart Assoc Date: 2016-07-28 Impact factor: 5.501
Authors: Ankit Maheshwari; Faye L Norby; Nicholas S Roetker; Elsayed Z Soliman; Ryan J Koene; Mary R Rooney; Wesley T O'Neal; Amil M Shah; Brian L Claggett; Scott D Solomon; Alvaro Alonso; Rebecca F Gottesman; Susan R Heckbert; Lin Y Chen Journal: Circulation Date: 2019-01-08 Impact factor: 29.690
Authors: Ryan J Koene; M Chadi Alraies; Faye L Norby; Elsayed Z Soliman; Ankit Maheshwari; Gregory Y H Lip; Alvaro Alonso; Lin Y Chen Journal: Am J Cardiol Date: 2018-11-06 Impact factor: 2.778
Authors: Francesco Bianco; Raffaele De Caterina; Alvin Chandra; Iolanda Aquila; Brian Claggett; Michelle C Johansen; Alexandra Gonçalves; Faye L Norby; Rebecca Cogswell; Elsayed Z Soliman; Rebecca Gottesman; Thomas Mosley; Alvaro Alonso; Amil Shah; Scott D Solomon; Lin Yee Chen Journal: J Am Heart Assoc Date: 2022-05-02 Impact factor: 6.106
Authors: Lin Yee Chen; Antonio Luiz Pinho Ribeiro; Pyotr G Platonov; Iwona Cygankiewicz; Elsayed Z Soliman; Bulent Gorenek; Takanori Ikeda; Vassilios P Vassilikos; Jonathan S Steinberg; Niraj Varma; Antoni Bayés-de-Luna; Adrian Baranchuk Journal: Circ Arrhythm Electrophysiol Date: 2022-03-25
Authors: Zakaria Almuwaqqat; Wesley T O'Neal; Muhammad Hammadah; Bruno B Lima; J Douglas Bremner; Elsayed Z Soliman; Amit J Shah; Arshed A Quyyumi; Viola Vaccarino Journal: J Electrocardiol Date: 2020-03-03 Impact factor: 1.438
Authors: Alejandra Gutierrez; Faye L Norby; Ankit Maheshwari; Mary R Rooney; Rebecca F Gottesman; Thomas H Mosley; Pamela L Lutsey; Niki Oldenburg; Elsayed Z Soliman; Alvaro Alonso; Lin Y Chen Journal: J Am Heart Assoc Date: 2019-12-13 Impact factor: 5.501