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Racial Differences in Atrial Cardiopathy Phenotypes in Patients With Ischemic Stroke
Hooman Kamel1, Kathleen Alwell2, Brett M Kissela2
1From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology (H.K., T.B., M.L.C.), Weill Cornell Medicine, New York, NY; Departments of Neurology and Rehabilitation Medicine (K.A., B.M.K., D.W., M.F., S.F., S.L.D., C.J.M., D.O.K.) and Emergency Medicine (K.W., O.A.), University of Cincinnati; Division of Biostatistics and Epidemiology (H.J.S.), Cincinnati Children's Hospital Medical Center; Department of Pediatrics (H.J.S.), University of Cincinnati College of Medicine, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Michael E. DeBakey VA Medical Center (S.M.), Houston, TX; Department of Epidemiology (E.B.L.), University of Alabama at Birmingham; and Division of Cardiology and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, and Department of Internal Medicine-Cardiology (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC. hok9010@med.cornell.edu.
Insights
Racial differences in atrial cardiopathy, a condition linked to stroke, were observed between Black and White patients. Black individuals showed smaller left atrial size but increased P-wave terminal force, indicating distinct stroke pathophysiology.
Area of Science:
- Cardiology
- Neurology
- Public Health
Background:
- Racial disparities in stroke incidence and outcomes are significant public health concerns.
- Atrial cardiopathy, characterized by left atrial structural and electrical abnormalities, is an emerging risk factor for stroke.
- The role of atrial cardiopathy in explaining racial differences in stroke risk is not well understood.
Purpose of the Study:
- To investigate potential racial differences in atrial cardiopathy phenotypes between Black and White patients experiencing ischemic stroke.
- To test the hypothesis that thrombogenic atrial cardiopathy contributes to stroke-related racial disparities.
Main Methods:
- Analysis of ECGs and echocardiogram reports from the Greater Cincinnati/Northern Kentucky Stroke Study (2010-2015).
- Exclusion of patients with atrial fibrillation or flutter.
- Measurement of P-wave terminal force in lead V1 (PTFV1) and left atrial diameter as markers of atrial cardiopathy.
- Linear regression models adjusted for demographic and vascular factors.
Main Results:
- Among 3,426 patients without AF/AFL, Black race was associated with smaller left atrial diameter (adjusted β = -0.15) compared to White patients.
- Black race was associated with greater P-wave terminal force in V1 (PTFV1) (adjusted β = 1.45), a marker of fibrosis and impaired conduction.
- These findings indicate distinct atrial cardiopathy phenotypes based on race in ischemic stroke patients.
Conclusions:
- Systematic racial differences in left atrial structure and pathophysiology exist in a population-based sample of ischemic stroke patients.
- These findings suggest that atrial cardiopathy may play a role in the observed racial disparities in stroke.
- Further research is warranted to elucidate the mechanisms and clinical implications of these racial differences in atrial cardiopathy.
Objective:
To test the hypothesis that thrombogenic atrial cardiopathy may be relevant to stroke-related racial disparities, we compared atrial cardiopathy phenotypes between Black vs White patients with ischemic stroke.
Methods:
We assessed markers of atrial cardiopathy in the Greater Cincinnati/Northern Kentucky Stroke Study, a study of stroke incidence in a population of 1.3 million. We obtained ECGs and reports of echocardiograms performed during evaluation of stroke during the 2010/2015 study periods. Patients with atrial fibrillation (AF) or flutter (AFL) were excluded. Investigators blinded to patients' characteristics measured P-wave terminal force in ECG lead V1 (PTFV1), a marker of left atrial fibrosis and impaired interatrial conduction, and abstracted left atrial diameter from echocardiogram reports. Linear regression was used to examine the association between race and atrial cardiopathy markers after adjustment for demographics, body mass index, and vascular comorbidities.
Results:
Among 3,426 ischemic stroke cases in Black or White patients without AF/AFL, 2,391 had a left atrial diameter measurement (mean, 3.65 ± 0.70 cm). Black race was associated with smaller left atrial diameter in unadjusted (β coefficient, -0.11; 95% confidence interval [CI], -0.17 to -0.05) and adjusted (β, -0.15; 95% CI, -0.21 to -0.09) models. PTFV1 measurements were available in 3,209 patients (mean, 3,434 ± 2,525 μV*ms). Black race was associated with greater PTFV1 in unadjusted (β, 1.59; 95% CI, 1.21-1.97) and adjusted (β, 1.45; 95% CI, 1.00-1.80) models.
Conclusions:
We found systematic Black-White racial differences in left atrial structure and pathophysiology in a population-based sample of patients with ischemic stroke.
Classification Of Evidence:
This study provides Class II evidence that atrial cardiopathy phenotypes differ in Black people with acute stroke compared to White people.
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