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P-Wave Indices and Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis
Jinli He1, Gary Tse2, Panagiotis Korantzopoulos1
1From the Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China (J.H., G.L., T.L.); Department of Medicine and Therapeutics (G.T.) and Li Ka Shing Institute of Health Science (G.T.), Chinese University of Hong Kong, SAR, People's Republic of China; First Department of Cardiology, University Hospital of Ioannina, Greece (P.K.); Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece (K.P.L.); Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (S.A.-H.-A.-S.); Weill Cornell Medical College, New York, NY (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.).
Insights
Electrocardiographic P-wave indices, including terminal force in lead V1, duration, and maximum area, effectively predict ischemic stroke risk. These markers aid in stratifying patients with atrial cardiomyopathy for stroke.
Area of Science:
- Cardiology
- Neurology
- Medical Diagnostics
Background:
- Atrial cardiomyopathy is a known risk factor for ischemic stroke.
- Electrocardiographic (ECG) parameters like P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are used to assess left atrial abnormalities, which are linked to atrial fibrillation.
- These ECG markers may offer insights into stroke risk prediction.
Purpose of the Study:
- To systematically review and meta-analyze the predictive value of P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area for ischemic stroke risk.
- To evaluate the utility of these electrocardiographic parameters in identifying individuals at higher risk of stroke.
Main Methods:
- A systematic literature search was conducted on PubMed and EMBASE databases up to December 2016.
- Studies investigating the association between P-wave indices and stroke risk were included.
- Fixed- and random-effects models were employed for meta-analysis to calculate overall effect estimates.
Main Results:
- Ten studies were included in the analysis.
- P-wave terminal force in lead V1 demonstrated independent predictive value for stroke, both continuously and categorically.
- P-wave duration was a significant predictor when analyzed categorically, and maximum P-wave area also predicted incident ischemic stroke risk.
Conclusions:
- P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are valuable electrocardiographic markers.
- These ECG parameters can be utilized for risk stratification of incident ischemic stroke.
Background And Purpose:
Atrial cardiomyopathy is associated with an increased risk of ischemic stroke. P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are electrocardiographic parameters that have been used to assess left atrial abnormalities related to developing atrial fibrillation. The aim of this systematic review and meta-analysis was to examine their values for predicting ischemic stroke risk.
Methods:
PubMed and EMBASE databases were searched until December 2016 for studies that evaluated the association between P-wave indices and stroke risk. Both fixed- and random-effects models were used to calculate the overall effect estimates.
Results:
Ten studies examining P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area were included. P-wave terminal force in lead V1 was found to be an independent predictor of stroke as both a continuous variable (odds ratio [OR] per 1 SD change, 1.18; 95% confidence interval [CI], 1.12-1.25; P<0.0001) and categorical variable (OR, 1.59; 95% CI, 1.10-2.28; P=0.01). P-wave duration was a significant predictor of incident ischemic stroke when analyzed as a categorical variable (OR, 1.86; 95% CI, 1.37-2.52; P<0.0001) but not when analyzed as a continuous variable (OR, 1.05; 95% CI, 0.98-1.13; P=0.15). Maximum P-wave area also predicted the risk of incident ischemic stroke (OR per 1 SD change, 1.10; 95% CI, 1.04-1.17).
Conclusions:
P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are useful electrocardiographic markers that can be used to stratify the risk of incident ischemic stroke.
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