Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients

Cortez, Daniel; Baturova, Maria; Lindgren, Arne; Carlson, Jonas; Shubik, Yuri V; Olsson, Bertil; Platonov, Pyotr G.

Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients

Mark

Cortez, Daniel ^LU ; Baturova, Maria ^LU ; Lindgren, Arne ^LU ; Carlson, Jonas ^LU

; Shubik, Yuri V ; Olsson, Bertil ^LU and Platonov, Pyotr G. ^LU (2017) In BMC Cardiovascular Disorders 17(1).

Abstract: Background: Atrial fibrillation (AF) is a known risk factor for ischemic stroke. Electrocardiographic predictors of AF in population studies such as the Framingham Heart Study, as well as in hypertensive patients have demonstrated a predictive value of the P-wave duration for development of AF. QRS vector magnitude has had a predictive value in ventricular arrhythmia development. We aimed to assess the value of the three-dimensional P-wave vector magnitude and its relationship to P-wave duration for prediction of new-onset AF after ischemic stroke. Methods: First-ever ischemic stroke patients without AF at inclusion in the Lund Stroke Register were included. Measurements of P wave duration (Pd), QRS duration, corrected QT interval, and... (More); Background: Atrial fibrillation (AF) is a known risk factor for ischemic stroke. Electrocardiographic predictors of AF in population studies such as the Framingham Heart Study, as well as in hypertensive patients have demonstrated a predictive value of the P-wave duration for development of AF. QRS vector magnitude has had a predictive value in ventricular arrhythmia development. We aimed to assess the value of the three-dimensional P-wave vector magnitude and its relationship to P-wave duration for prediction of new-onset AF after ischemic stroke. Methods: First-ever ischemic stroke patients without AF at inclusion in the Lund Stroke Register were included. Measurements of P wave duration (Pd), QRS duration, corrected QT interval, and PQ interval were performed automatically using the University of Glasgow 12-lead ECG analysis algorithm. The P-wave vector magnitude (Pvm) was calculated automatically as the square root of the sum of the squared P-wave magnitudes in leads V6, II and one half of the P-wave amplitude in V2 ( PV 6 2 + PII 2 + 0.5 PV 2 2 $$ \sqrt(PV(6)^2+(PII)^2+(\left((0.5)^(\ast )PV2\right))^2) $$ ), based on the P-wave magnitude (Pvm) as defined by the visually transformed Kors' Quasi-orthogonal method. Results: The median age was 73 (IQR 63-80) years at stroke onset (135 males, 92 females). Multivariate predictors of new-onset atrial fibrillation included age>65years, hypertension, and Pd/Pvm. A cut-off value of 870ms/mV gave sensitivity, specificity, positive and negative predictive values of 51, 79, 30 and 87%, respectively. The Pd/Pvm was the only ECG predictor of AF with a significant multivariate hazard ratio of 2.02 (95% CI 1.18 to 3.46, p=0.010). Conclusion: P-wave dispersion as measured by the Pd/Pvm was the only ECG parameter measured which independently predicted subsequent AF identification in a cohort of stroke patients. Further prospective studies in larger cohorts are needed to validate its clinical usefulness.
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Please use this url to cite or link to this publication: https://lup.lub.lu.se/record/d55f4375-048e-471c-bd99-eeba488fcb1d

author

Cortez, Daniel ^LU ; Baturova, Maria ^LU ; Lindgren, Arne ^LU ; Carlson, Jonas ^LU

; Shubik, Yuri V ; Olsson, Bertil ^LU and Platonov, Pyotr G. ^LU

organization

publishing date

2017-07-24

type

Contribution to journal

publication status

published

subject

Cardiac and Cardiovascular Systems

keywords

Atrial fibrillation, Ischemic stroke, P-wave duration, P-wave vector magnitude

in

BMC Cardiovascular Disorders

volume

17

issue

1

article number

200

publisher

BioMed Central (BMC)

external identifiers

scopus:85025651227
pmid:28738786
wos:000406330200005

ISSN

1471-2261

DOI

10.1186/s12872-017-0631-1

language

English

LU publication?

yes

id

d55f4375-048e-471c-bd99-eeba488fcb1d

date added to LUP

2017-08-24 15:38:51

date last changed

2024-03-17 19:25:20

@article{d55f4375-048e-471c-bd99-eeba488fcb1d,
  abstract     = {{<p>Background: Atrial fibrillation (AF) is a known risk factor for ischemic stroke. Electrocardiographic predictors of AF in population studies such as the Framingham Heart Study, as well as in hypertensive patients have demonstrated a predictive value of the P-wave duration for development of AF. QRS vector magnitude has had a predictive value in ventricular arrhythmia development. We aimed to assess the value of the three-dimensional P-wave vector magnitude and its relationship to P-wave duration for prediction of new-onset AF after ischemic stroke. Methods: First-ever ischemic stroke patients without AF at inclusion in the Lund Stroke Register were included. Measurements of P wave duration (Pd), QRS duration, corrected QT interval, and PQ interval were performed automatically using the University of Glasgow 12-lead ECG analysis algorithm. The P-wave vector magnitude (Pvm) was calculated automatically as the square root of the sum of the squared P-wave magnitudes in leads V6, II and one half of the P-wave amplitude in V2 ( PV 6 2 + PII 2 + 0.5 PV 2 2 $$ \sqrt(PV(6)^2+(PII)^2+(\left((0.5)^(\ast )PV2\right))^2) $$ ), based on the P-wave magnitude (Pvm) as defined by the visually transformed Kors' Quasi-orthogonal method. Results: The median age was 73 (IQR 63-80) years at stroke onset (135 males, 92 females). Multivariate predictors of new-onset atrial fibrillation included age&gt;65years, hypertension, and Pd/Pvm. A cut-off value of 870ms/mV gave sensitivity, specificity, positive and negative predictive values of 51, 79, 30 and 87%, respectively. The Pd/Pvm was the only ECG predictor of AF with a significant multivariate hazard ratio of 2.02 (95% CI 1.18 to 3.46, p=0.010). Conclusion: P-wave dispersion as measured by the Pd/Pvm was the only ECG parameter measured which independently predicted subsequent AF identification in a cohort of stroke patients. Further prospective studies in larger cohorts are needed to validate its clinical usefulness.</p>}},
  author       = {{Cortez, Daniel and Baturova, Maria and Lindgren, Arne and Carlson, Jonas and Shubik, Yuri V and Olsson, Bertil and Platonov, Pyotr G.}},
  issn         = {{1471-2261}},
  keywords     = {{Atrial fibrillation; Ischemic stroke; P-wave duration; P-wave vector magnitude}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{BMC Cardiovascular Disorders}},
  title        = {{Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients}},
  url          = {{http://dx.doi.org/10.1186/s12872-017-0631-1}},
  doi          = {{10.1186/s12872-017-0631-1}},
  volume       = {{17}},
  year         = {{2017}},
}

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Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients