Electrocardiographic left atrial abnormality and silent vascular brain injury: The Northern Manhattan Study

We hypothesized that P wave terminal Force in the V1 lead (PTFV₁) would be associated with leukoaraiosis and subclinical infarcts, especially cortical infarcts, in a population-based, multi-ethnic cohort. Methods PTFV₁ was collected manually from baseline electrocardiograms of clinically stroke-free Northern Manhattan Study participants. Investigators read brain MRIs for superficial infarcts, deep infarcts, and white matter hyperintensity volume (WMHV). WMHV was adjusted for head size and log transformed, achieving a normal distribution. Logistic regression models investigated the association of PTFV₁ with cortical and with all subclinical infarcts. Linear regression models examined logWMHV. Models were adjusted for demographics and risk factors. Results Among 1174 participants with PTFV₁ measurements, the mean age at MRI was 70±9 years. Participants were 14.4% white, 17.6% black, and 65.8% Hispanic. Mean PTFV₁ was 3587.35±2315.62 ìV-ms. Of the 170 subclinical infarcts, 40 were cortical. PTFV₁ ≥5000 μV-ms was associated with WMHV in a fully adjusted model (mean difference in logWMHV 0.15, 95% confidence interval 0.01±0.28). PTFV₁ exhibited a trend toward an association with cortical infarcts (unadjusted OR per SD change logPTFV₁ 1.30, 95% CI 0.94±1.81), but not with all subclinical infarcts. Conclusion Electrocardiographic evidence of left atrial abnormality was associated with leukoaraiosis.