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Association between left atrial abnormality on ECG and vascular brain injury on MRI in the Cardiovascular Health Study.
Tuesday,2015-04-07 14:29 America/Los_Angeles — zdrager
| Title | Association between left atrial abnormality on ECG and vascular brain injury on MRI in the Cardiovascular Health Study. |
| Publication Type | Journal Article |
| Year of Publication | 2015 |
| Authors | Kamel, H, Bartz, TM, Longstreth, WT, Okin, PM, Thacker, EL, Patton, KK, Stein, PK, Gottesman, RF, Heckbert, SR, Kronmal, RA, Elkind, MSV, Soliman, EZ |
| Journal | Stroke |
| Volume | 46 |
| Issue | 3 |
| Pagination | 711-6 |
| Date Published | 2015 Mar |
| ISSN | 1524-4628 |
| Keywords | Aged, Atrial Fibrillation, Brain, Brain Infarction, Cardiovascular Diseases, Cerebrovascular Trauma, Electrocardiography, Female, Heart Atria, Heart Diseases, Humans, Linear Models, Magnetic Resonance Imaging, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Regression Analysis, Risk Factors, Treatment Outcome |
| Abstract | <p><b>BACKGROUND AND PURPOSE: </b>Emerging evidence suggests that atrial disease is associated with vascular brain injury in the absence of atrial fibrillation.</p><p><b>METHODS: </b>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.</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSIONS: </b>ECG left atrial abnormality is associated with vascular brain injury in the absence of documented atrial fibrillation.</p> |
| DOI | 10.1161/STROKEAHA.114.007762 |
| Alternate Journal | Stroke |
| PubMed ID | 25677594 |
| PubMed Central ID | PMC4342300 |
| Grant List | HHSN268200800007C / HL / NHLBI NIH HHS / United States HHSN268200800007C / / PHS HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States HHSN268201200036C / / PHS HHS / United States K23 NS082367 / NS / NINDS NIH HHS / United States K23NS082367 / NS / NINDS NIH HHS / United States N01 HC015103 / HC / NHLBI NIH HHS / United States N01HC15103 / HC / NHLBI NIH HHS / United States N01HC55222 / HC / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01HC85079 / HC / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States N01HC85080 / HC / NHLBI NIH HHS / United States N01HC85080 / HL / NHLBI NIH HHS / United States N01HC85081 / HC / NHLBI NIH HHS / United States N01HC85081 / HL / NHLBI NIH HHS / United States N01HC85082 / HC / NHLBI NIH HHS / United States N01HC85082 / HL / NHLBI NIH HHS / United States N01HC85083 / HC / NHLBI NIH HHS / United States N01HC85083 / HL / NHLBI NIH HHS / United States N01HC85086 / HC / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States R01AG023629 / AG / NIA NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States U01HL080295 / HL / NHLBI NIH HHS / United States |