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Association of abnormal p-wave parameters with brain MRI morphology: The atherosclerosis risk in communities
Jorge L Reyes1, Faye L Norby2, Yuekai Ji1
1Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Background:
Recent evidence indicates that abnormal P-wave parameters (PWPs)-ECG markers of atrial myopathy-are associated with incident dementia, independent of atrial fibrillation (AF) and clinical ischemic stroke. However, the mechanisms remain unclear and may include subclinical vascular brain injury. Hence, we evaluated the association of abnormal PWPs with brain MRI correlates of vascular brain injury in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS).
Methods:
ARIC-NCS participants who underwent 3T brain MRI scans in 2011-2013 were included. PWPs were measured from standard 12-lead ECGs. Brain MRI outcomes included cortical infarcts, lacunar infarcts, cerebral microhemorrhages, brain volumes, and white matter disease (WMD) volume. We used weighted multivariable logistic and linear regression to evaluate the associations of abnormal PWPs with brain MRI outcomes.
Results:
Among 1715 participants (mean age, 76.1 years; 61% women; 29% Black), 797 (46%) had ≥1 abnormal PWP. After multivariable adjustment, including adjusting for prevalent AF, abnormal P-wave terminal force in lead V1 (aPTFV1) and prolonged P-wave duration (PPWD) were associated with increased odds of both cortical (OR 1.41; 95% CI, 1.14 to 1.74 and OR 1.30; 95% CI, 1.04 to 1.63, respectively) and lacunar infarcts (OR 1.36; 95% CI, 1.15 to 1.63 and OR 1.37; 95% CI, 1.15 to 1.65, respectively). Advanced interatrial block (aIAB) was associated with higher odds of subcortical microhemorrhage (OR 2.04; 95% CI, 1.36 to 3.06). Other than a significant association between aPTFV1 with lower parietal lobe volume, there were no other significant associations with brain or WMD volume.
Conclusion:
In this exploratory analysis of a US community-based cohort, ECG surrogates of atrial myopathy are associated with a higher prevalence of brain infarcts and microhemorrhage, suggesting subclinical vascular brain injury as a possible mechanism underlying the association of atrial myopathy with dementia.
Insights
Abnormal P-wave parameters (PWPs) on ECGs, indicating atrial myopathy, are linked to brain infarcts and microhemorrhages. These findings suggest subclinical vascular brain injury may connect atrial myopathy to dementia risk.
Area of Science:
- Cardiology
- Neurology
- Gerontology
Background:
- Abnormal P-wave parameters (PWPs), markers of atrial myopathy, are linked to incident dementia.
- The mechanisms connecting atrial myopathy to dementia, independent of atrial fibrillation (AF), are not fully understood.
- Subclinical vascular brain injury is a potential mechanism linking atrial myopathy to cognitive decline.
Purpose of the Study:
- To investigate the association between abnormal PWPs and brain magnetic resonance imaging (MRI) markers of vascular brain injury.
- To explore potential mechanisms linking atrial myopathy to dementia in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS).
Main Methods:
- Utilized brain MRI data from ARIC-NCS participants (2011-2013).
- Measured PWPs from standard 12-lead ECGs.
- Assessed brain MRI outcomes including infarcts, microhemorrhages, brain volumes, and white matter disease (WMD) using weighted multivariable regression.
Main Results:
- Abnormal P-wave terminal force in lead V1 (aPTFV1) and prolonged P-wave duration (PPWD) were associated with increased odds of cortical and lacunar infarcts.
- Advanced interatrial block (aIAB) showed association with higher odds of subcortical microhemorrhage.
- No significant associations were found with overall brain or WMD volume, except for aPTFV1 with lower parietal lobe volume.
Conclusions:
- ECG-derived atrial myopathy markers are associated with a higher prevalence of brain infarcts and microhemorrhages.
- These findings suggest subclinical vascular brain injury as a potential mechanism linking atrial myopathy to dementia.
- The study highlights the role of atrial myopathy in cerebrovascular health and cognitive impairment.
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