Refining prediction of stroke in sinus node dysfunction patients without atrial fibrillation using a P-combined...

Area of Science:

• Cardiology
• Neurology
• Medical Diagnostics

Background:

• Isolated sinus node dysfunction (ISND) is characterized by sinus node dysfunction without atrial fibrillation.
• ISND populations exhibit an elevated risk of ischemic stroke (IS), yet current guidelines do not advocate for anticoagulation.
• P-wave indices, reflecting atrial remodeling, and the CHA2DS2-VASc score are potential tools for IS risk stratification in ISND.

Purpose of the Study:

• To evaluate the predictive capability of P-wave indices and the CHA2DS2-VASc score for IS in ISND patients.
• To develop and validate an improved risk stratification score for IS in ISND.
• To assess the clinical effectiveness of the novel P-combined score compared to existing methods.

Main Methods:

• A multi-center longitudinal cohort study involving development (n=1185) and validation (n=988) cohorts of ISND patients.
• Analysis of P-wave indices, specifically P-wave terminal force in lead V1 (PTFV1), and its association with IS events.
• Development of a P-combined score by integrating PTFV1 with the CHA2DS2-VASc score, followed by assessment of discrimination, calibration, and clinical utility.

Main Results:

• During a median follow-up of 3.02 years, 10.46% of ISND patients developed IS (1.63%/year).
• PTFV1 was identified as the sole significantly abnormal P-wave index associated with increased IS risk (aHR: 2.56).
• The P-combined score demonstrated improved IS prediction compared to the CHA2DS2-VASc score alone, enhancing Harrell's C-statistic in both development and validation cohorts.

Conclusions:

• Chinese ISND patients experience a higher incidence of IS than the general population.
• The PTFV1-combined CHA2DS2-VASc score offers superior risk stratification for ISND-related IS compared to the CHA2DS2-VASc score alone.
• This novel score holds promise for guiding clinical management decisions in ISND patients at risk for stroke.