Abstract
Background and Purpose-Electrocardiographic left atrial abnormality has been associated with stroke independently of atrial fibrillation (AF), suggesting that atrial thromboembolism may occur in the absence of AF. If true, we would expect an association with cryptogenic or cardioembolic stroke rather than noncardioembolic stroke. Methods-We conducted a case-cohort analysis in the Northern Manhattan Study, a prospective cohort study of stroke risk factors. P-wave terminal force in lead V1 was manually measured from baseline ECGs of participants in sinus rhythm who subsequently had ischemic stroke (n=241) and a randomly selected subcohort without stroke (n=798). Weighted Cox proportional hazard models were used to examine the association between P-wave terminal force in lead V1 and stroke etiologic subtypes while adjusting for baseline demographic characteristics, history of AF, heart failure, diabetes mellitus, hypertension, tobacco use, and lipid levels. Results-Mean P-wave terminal force in lead V1 was 4452 (±3368) μV∗ms among stroke cases and 3934 (±2541) μV∗ms in the subcohort. P-wave terminal force in lead V1 was associated with ischemic stroke (adjusted hazard ratio per SD, 1.20; 95% confidence interval, 1.03-1.39) and the composite of cryptogenic or cardioembolic stroke (adjusted hazard ratio per SD, 1.31; 95% confidence interval, 1.08-1.58). There was no definite association with noncardioembolic stroke subtypes (adjusted hazard ratio per SD, 1.14; 95% confidence interval, 0.92-1.40). Results were similar after excluding participants with a history of AF at baseline or new AF during follow-up. Conclusions-ECG-defined left atrial abnormality was associated with incident cryptogenic or cardioembolic stroke independently of the presence of AF, suggesting atrial thromboembolism may occur without recognized AF.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 3208-3212 |
| Number of pages | 5 |
| Journal | Stroke |
| Volume | 46 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 1 2015 |
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Keywords
- atrial fibrillation
- cardiomyopathies
- cohort studies
- embolism
- stroke
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Clinical Neurology
- Advanced and Specialized Nursing
Cite this
Electrocardiographic left atrial abnormality and risk of stroke : Northern manhattan study. / Kamel, Hooman; Hunter, Madeleine; Moon, Yeseon P.; Yaghi, Shadi; Cheung, Ken; Di Tullio, Marco R.; Okin, Peter M.; Sacco, Ralph L; Soliman, Elsayed Z.; Elkind, Mitchell S V.
In: Stroke, Vol. 46, No. 11, 01.11.2015, p. 3208-3212.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Electrocardiographic left atrial abnormality and risk of stroke
T2 - Northern manhattan study
AU - Kamel, Hooman
AU - Hunter, Madeleine
AU - Moon, Yeseon P.
AU - Yaghi, Shadi
AU - Cheung, Ken
AU - Di Tullio, Marco R.
AU - Okin, Peter M.
AU - Sacco, Ralph L
AU - Soliman, Elsayed Z.
AU - Elkind, Mitchell S V
PY - 2015/11/1
Y1 - 2015/11/1
N2 - Background and Purpose-Electrocardiographic left atrial abnormality has been associated with stroke independently of atrial fibrillation (AF), suggesting that atrial thromboembolism may occur in the absence of AF. If true, we would expect an association with cryptogenic or cardioembolic stroke rather than noncardioembolic stroke. Methods-We conducted a case-cohort analysis in the Northern Manhattan Study, a prospective cohort study of stroke risk factors. P-wave terminal force in lead V1 was manually measured from baseline ECGs of participants in sinus rhythm who subsequently had ischemic stroke (n=241) and a randomly selected subcohort without stroke (n=798). Weighted Cox proportional hazard models were used to examine the association between P-wave terminal force in lead V1 and stroke etiologic subtypes while adjusting for baseline demographic characteristics, history of AF, heart failure, diabetes mellitus, hypertension, tobacco use, and lipid levels. Results-Mean P-wave terminal force in lead V1 was 4452 (±3368) μV∗ms among stroke cases and 3934 (±2541) μV∗ms in the subcohort. P-wave terminal force in lead V1 was associated with ischemic stroke (adjusted hazard ratio per SD, 1.20; 95% confidence interval, 1.03-1.39) and the composite of cryptogenic or cardioembolic stroke (adjusted hazard ratio per SD, 1.31; 95% confidence interval, 1.08-1.58). There was no definite association with noncardioembolic stroke subtypes (adjusted hazard ratio per SD, 1.14; 95% confidence interval, 0.92-1.40). Results were similar after excluding participants with a history of AF at baseline or new AF during follow-up. Conclusions-ECG-defined left atrial abnormality was associated with incident cryptogenic or cardioembolic stroke independently of the presence of AF, suggesting atrial thromboembolism may occur without recognized AF.
AB - Background and Purpose-Electrocardiographic left atrial abnormality has been associated with stroke independently of atrial fibrillation (AF), suggesting that atrial thromboembolism may occur in the absence of AF. If true, we would expect an association with cryptogenic or cardioembolic stroke rather than noncardioembolic stroke. Methods-We conducted a case-cohort analysis in the Northern Manhattan Study, a prospective cohort study of stroke risk factors. P-wave terminal force in lead V1 was manually measured from baseline ECGs of participants in sinus rhythm who subsequently had ischemic stroke (n=241) and a randomly selected subcohort without stroke (n=798). Weighted Cox proportional hazard models were used to examine the association between P-wave terminal force in lead V1 and stroke etiologic subtypes while adjusting for baseline demographic characteristics, history of AF, heart failure, diabetes mellitus, hypertension, tobacco use, and lipid levels. Results-Mean P-wave terminal force in lead V1 was 4452 (±3368) μV∗ms among stroke cases and 3934 (±2541) μV∗ms in the subcohort. P-wave terminal force in lead V1 was associated with ischemic stroke (adjusted hazard ratio per SD, 1.20; 95% confidence interval, 1.03-1.39) and the composite of cryptogenic or cardioembolic stroke (adjusted hazard ratio per SD, 1.31; 95% confidence interval, 1.08-1.58). There was no definite association with noncardioembolic stroke subtypes (adjusted hazard ratio per SD, 1.14; 95% confidence interval, 0.92-1.40). Results were similar after excluding participants with a history of AF at baseline or new AF during follow-up. Conclusions-ECG-defined left atrial abnormality was associated with incident cryptogenic or cardioembolic stroke independently of the presence of AF, suggesting atrial thromboembolism may occur without recognized AF.
KW - atrial fibrillation
KW - cardiomyopathies
KW - cohort studies
KW - embolism
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=84946474953&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84946474953&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.115.009989
DO - 10.1161/STROKEAHA.115.009989
M3 - Article
C2 - 26396031
AN - SCOPUS:84946474953
VL - 46
SP - 3208
EP - 3212
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 11
ER -