Association between left atrial abnormality on ECG and vascular brain injury on MRI in the Cardiovascular Health Study

Hooman Kamel, Traci M. Bartz, W. T. Longstreth, Peter M. Okin, Evan L. Thacker, Kristen K. Patton, Phyllis K. Stein, Rebecca F Gottesman, Susan R. Heckbert, Richard A. Kronmal, Mitchell S V Elkind, Elsayed Z. Soliman

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)711-716
Number of pages6
JournalStroke
Volume46
Issue number3
DOIs
StatePublished - Mar 1 2015

Fingerprint

Cerebrovascular Trauma
Leukoaraiosis
Electrocardiography
Atrial Fibrillation
Confidence Intervals
Health
Linear Models
Independent Living
Lead
Brain

Keywords

  • Arrhythmias
  • Cardiac
  • Electrocardiography
  • Embolism
  • Heart atrium
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Kamel, H., Bartz, T. M., Longstreth, W. T., Okin, P. M., Thacker, E. L., Patton, K. K., ... Soliman, E. Z. (2015). Association between left atrial abnormality on ECG and vascular brain injury on MRI in the Cardiovascular Health Study. Stroke, 46(3), 711-716. https://doi.org/10.1161/STROKEAHA.114.007762

Association between left atrial abnormality on ECG and vascular brain injury on MRI in the Cardiovascular Health Study. / Kamel, Hooman; Bartz, Traci M.; Longstreth, W. T.; Okin, Peter M.; Thacker, Evan L.; Patton, Kristen K.; Stein, Phyllis K.; Gottesman, Rebecca F; Heckbert, Susan R.; Kronmal, Richard A.; Elkind, Mitchell S V; Soliman, Elsayed Z.

In: Stroke, Vol. 46, No. 3, 01.03.2015, p. 711-716.

Research output: Contribution to journalArticle

Kamel, H, Bartz, TM, Longstreth, WT, Okin, PM, Thacker, EL, Patton, KK, Stein, PK, Gottesman, RF, Heckbert, SR, Kronmal, RA, Elkind, MSV & Soliman, EZ 2015, 'Association between left atrial abnormality on ECG and vascular brain injury on MRI in the Cardiovascular Health Study', Stroke, vol. 46, no. 3, pp. 711-716. https://doi.org/10.1161/STROKEAHA.114.007762
Kamel, Hooman ; Bartz, Traci M. ; Longstreth, W. T. ; Okin, Peter M. ; Thacker, Evan L. ; Patton, Kristen K. ; Stein, Phyllis K. ; Gottesman, Rebecca F ; Heckbert, Susan R. ; Kronmal, Richard A. ; Elkind, Mitchell S V ; Soliman, Elsayed Z. / Association between left atrial abnormality on ECG and vascular brain injury on MRI in the Cardiovascular Health Study. In: Stroke. 2015 ; Vol. 46, No. 3. pp. 711-716.
@article{53dfc8a2953c4b35a96eaea4ae6aea02,
title = "Association between left atrial abnormality on ECG and vascular brain injury on MRI in the Cardiovascular Health Study",
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.",
keywords = "Arrhythmias, Cardiac, Electrocardiography, Embolism, Heart atrium, Stroke",
author = "Hooman Kamel and Bartz, {Traci M.} and Longstreth, {W. T.} and Okin, {Peter M.} and Thacker, {Evan L.} and Patton, {Kristen K.} and Stein, {Phyllis K.} and Gottesman, {Rebecca F} and Heckbert, {Susan R.} and Kronmal, {Richard A.} and Elkind, {Mitchell S V} and Soliman, {Elsayed Z.}",
year = "2015",
month = "3",
day = "1",
doi = "10.1161/STROKEAHA.114.007762",
language = "English (US)",
volume = "46",
pages = "711--716",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Association between left atrial abnormality on ECG and vascular brain injury on MRI in the Cardiovascular Health Study

AU - Kamel, Hooman

AU - Bartz, Traci M.

AU - Longstreth, W. T.

AU - Okin, Peter M.

AU - Thacker, Evan L.

AU - Patton, Kristen K.

AU - Stein, Phyllis K.

AU - Gottesman, Rebecca F

AU - Heckbert, Susan R.

AU - Kronmal, Richard A.

AU - Elkind, Mitchell S V

AU - Soliman, Elsayed Z.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - 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.

AB - 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.

KW - Arrhythmias

KW - Cardiac

KW - Electrocardiography

KW - Embolism

KW - Heart atrium

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=84930339509&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84930339509&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.114.007762

DO - 10.1161/STROKEAHA.114.007762

M3 - Article

VL - 46

SP - 711

EP - 716

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 3

ER -