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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.

Neurology
|November 26, 2020
PubMed
Summary
This summary is machine-generated.

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.

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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.