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

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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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Atrial fibrillation, Ischemic stroke, P-wave duration, P-wave vector magnitude
in
BMC Cardiovascular Disorders
volume
17
issue
1
publisher
BioMed Central
external identifiers
  • scopus:85025651227
  • 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
2018-04-01 04:34:50
@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>},
  articleno    = {200},
  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},
  keyword      = {Atrial fibrillation,Ischemic stroke,P-wave duration,P-wave vector magnitude},
  language     = {eng},
  month        = {07},
  number       = {1},
  publisher    = {BioMed Central},
  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},
  volume       = {17},
  year         = {2017},
}