Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients
(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.
(Less)
- 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
- 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
- 2025-01-07 19:19:44
@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>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}}, }