Relation of Electrocardiographic Left Atrial Abnormalities to Risk of Stroke in Patients with Atrial Fibrillation

Yuko Y. Inoue, Esra G. Ipek, Irfan M. Khurram, Luisa Ciuffo, Jonathan Chrispin, Stefan Zimmerman, Joseph Marine, John Rickard, David D Spragg, Saman Nazarian, Kengo Kusano, Joao Lima, Ronald D Berger, Hugh Calkins, Hiroshi Ashikaga

Research output: Contribution to journalArticle

Abstract

The P-wave terminal force in lead V1 (PTFV1) on the 12-lead electrocardiogram (ECG) quantifies left atrial (LA) structural and electrophysiologic abnormalities. We aimed to evaluate the association between PTFV1 and cerebrovascular accident (CVA) as well as LA structure and function in patients with atrial fibrillation (AF). We conducted a cross-sectional study of 229 patients with AF (60 ± 10years, 72% men) with (n = 21) and without (n = 208) a history of CVA, who underwent preablation ECG and cardiac magnetic resonance in sinus rhythm. PTFV1 was defined as the duration (in milliseconds) of the downward deflection of the P wave in lead V1 multiplied by the absolute value of its amplitude (in microvolts) on ECG. PTFV1 is associated with LA minimum volume (Vmin) and left ventricular ejection fraction but not associated with the extent of LA fibrosis quantified by cardiac magnetic resonance late gadolinium enhancement. In addition, PTFV1 is associated with CVA independent of the CHA2DS2-VASc score and LA Vmin (odds ratio 1.23; 95% confidence interval 1.08 to 1.40; p = 0.002). Furthermore, PTFV1 has an incremental value over the CHA2DS2-VASc score as a marker of CVA (p <0.001). In conclusion, ECG-defined PTFV1 is independent marker of stroke in patients with AF and reflects the underlying LA remodeling. Our findings suggest that evaluation of PTFV1 can improve the current risk stratification of stroke.

Original languageEnglish (US)
Pages (from-to)242-247
Number of pages6
JournalAmerican Journal of Cardiology
Volume122
Issue number2
DOIs
StatePublished - Jul 15 2018

Fingerprint

Atrial Fibrillation
Stroke
Electrocardiography
Magnetic Resonance Spectroscopy
Left Atrial Function
Lead
Atrial Remodeling
Gadolinium
Stroke Volume
Fibrosis
Cross-Sectional Studies
Odds Ratio
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relation of Electrocardiographic Left Atrial Abnormalities to Risk of Stroke in Patients with Atrial Fibrillation. / Inoue, Yuko Y.; Ipek, Esra G.; Khurram, Irfan M.; Ciuffo, Luisa; Chrispin, Jonathan; Zimmerman, Stefan; Marine, Joseph; Rickard, John; Spragg, David D; Nazarian, Saman; Kusano, Kengo; Lima, Joao; Berger, Ronald D; Calkins, Hugh; Ashikaga, Hiroshi.

In: American Journal of Cardiology, Vol. 122, No. 2, 15.07.2018, p. 242-247.

Research output: Contribution to journalArticle

@article{d8f8f3d40878498488a9b558a5211caf,
title = "Relation of Electrocardiographic Left Atrial Abnormalities to Risk of Stroke in Patients with Atrial Fibrillation",
abstract = "The P-wave terminal force in lead V1 (PTFV1) on the 12-lead electrocardiogram (ECG) quantifies left atrial (LA) structural and electrophysiologic abnormalities. We aimed to evaluate the association between PTFV1 and cerebrovascular accident (CVA) as well as LA structure and function in patients with atrial fibrillation (AF). We conducted a cross-sectional study of 229 patients with AF (60 ± 10years, 72{\%} men) with (n = 21) and without (n = 208) a history of CVA, who underwent preablation ECG and cardiac magnetic resonance in sinus rhythm. PTFV1 was defined as the duration (in milliseconds) of the downward deflection of the P wave in lead V1 multiplied by the absolute value of its amplitude (in microvolts) on ECG. PTFV1 is associated with LA minimum volume (Vmin) and left ventricular ejection fraction but not associated with the extent of LA fibrosis quantified by cardiac magnetic resonance late gadolinium enhancement. In addition, PTFV1 is associated with CVA independent of the CHA2DS2-VASc score and LA Vmin (odds ratio 1.23; 95{\%} confidence interval 1.08 to 1.40; p = 0.002). Furthermore, PTFV1 has an incremental value over the CHA2DS2-VASc score as a marker of CVA (p <0.001). In conclusion, ECG-defined PTFV1 is independent marker of stroke in patients with AF and reflects the underlying LA remodeling. Our findings suggest that evaluation of PTFV1 can improve the current risk stratification of stroke.",
author = "Inoue, {Yuko Y.} and Ipek, {Esra G.} and Khurram, {Irfan M.} and Luisa Ciuffo and Jonathan Chrispin and Stefan Zimmerman and Joseph Marine and John Rickard and Spragg, {David D} and Saman Nazarian and Kengo Kusano and Joao Lima and Berger, {Ronald D} and Hugh Calkins and Hiroshi Ashikaga",
year = "2018",
month = "7",
day = "15",
doi = "10.1016/j.amjcard.2018.03.369",
language = "English (US)",
volume = "122",
pages = "242--247",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "2",

}

TY - JOUR

T1 - Relation of Electrocardiographic Left Atrial Abnormalities to Risk of Stroke in Patients with Atrial Fibrillation

AU - Inoue, Yuko Y.

AU - Ipek, Esra G.

AU - Khurram, Irfan M.

AU - Ciuffo, Luisa

AU - Chrispin, Jonathan

AU - Zimmerman, Stefan

AU - Marine, Joseph

AU - Rickard, John

AU - Spragg, David D

AU - Nazarian, Saman

AU - Kusano, Kengo

AU - Lima, Joao

AU - Berger, Ronald D

AU - Calkins, Hugh

AU - Ashikaga, Hiroshi

PY - 2018/7/15

Y1 - 2018/7/15

N2 - The P-wave terminal force in lead V1 (PTFV1) on the 12-lead electrocardiogram (ECG) quantifies left atrial (LA) structural and electrophysiologic abnormalities. We aimed to evaluate the association between PTFV1 and cerebrovascular accident (CVA) as well as LA structure and function in patients with atrial fibrillation (AF). We conducted a cross-sectional study of 229 patients with AF (60 ± 10years, 72% men) with (n = 21) and without (n = 208) a history of CVA, who underwent preablation ECG and cardiac magnetic resonance in sinus rhythm. PTFV1 was defined as the duration (in milliseconds) of the downward deflection of the P wave in lead V1 multiplied by the absolute value of its amplitude (in microvolts) on ECG. PTFV1 is associated with LA minimum volume (Vmin) and left ventricular ejection fraction but not associated with the extent of LA fibrosis quantified by cardiac magnetic resonance late gadolinium enhancement. In addition, PTFV1 is associated with CVA independent of the CHA2DS2-VASc score and LA Vmin (odds ratio 1.23; 95% confidence interval 1.08 to 1.40; p = 0.002). Furthermore, PTFV1 has an incremental value over the CHA2DS2-VASc score as a marker of CVA (p <0.001). In conclusion, ECG-defined PTFV1 is independent marker of stroke in patients with AF and reflects the underlying LA remodeling. Our findings suggest that evaluation of PTFV1 can improve the current risk stratification of stroke.

AB - The P-wave terminal force in lead V1 (PTFV1) on the 12-lead electrocardiogram (ECG) quantifies left atrial (LA) structural and electrophysiologic abnormalities. We aimed to evaluate the association between PTFV1 and cerebrovascular accident (CVA) as well as LA structure and function in patients with atrial fibrillation (AF). We conducted a cross-sectional study of 229 patients with AF (60 ± 10years, 72% men) with (n = 21) and without (n = 208) a history of CVA, who underwent preablation ECG and cardiac magnetic resonance in sinus rhythm. PTFV1 was defined as the duration (in milliseconds) of the downward deflection of the P wave in lead V1 multiplied by the absolute value of its amplitude (in microvolts) on ECG. PTFV1 is associated with LA minimum volume (Vmin) and left ventricular ejection fraction but not associated with the extent of LA fibrosis quantified by cardiac magnetic resonance late gadolinium enhancement. In addition, PTFV1 is associated with CVA independent of the CHA2DS2-VASc score and LA Vmin (odds ratio 1.23; 95% confidence interval 1.08 to 1.40; p = 0.002). Furthermore, PTFV1 has an incremental value over the CHA2DS2-VASc score as a marker of CVA (p <0.001). In conclusion, ECG-defined PTFV1 is independent marker of stroke in patients with AF and reflects the underlying LA remodeling. Our findings suggest that evaluation of PTFV1 can improve the current risk stratification of stroke.

UR - http://www.scopus.com/inward/record.url?scp=85048715685&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048715685&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2018.03.369

DO - 10.1016/j.amjcard.2018.03.369

M3 - Article

C2 - 29933926

AN - SCOPUS:85048715685

VL - 122

SP - 242

EP - 247

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 2

ER -