Electrocardiographic Indicators of Left Atrial Remodeling in Ischemic Stroke Patients with Atrial Fibrillation

BACKGROUND Left atrial (LA) remodeling (LAR) is a risk factor for atrial fibrillation (AF) and ischemic stroke (IS). LAR can be detected on electrocardiogram (ECG) by P wave indices. The aim of this study was to search for noninvasively assessed LAR markers associated with the history of IS in patients with AF, considering differences between males and females. MATERIAL AND METHODS This retrospective study included a group of 256 patients, aged 76.19 (±9.64) years, with documented AF and after IS. The control group consisted of 70 people aged 68.43 (±7.38) years with AF but without IS. The collected study material included ECG (longest P wave duration [Pmax], P wave duration [PWD], P wave dispersion [PWDI], P wave terminal force in lead V₁ [PWTFV₁], negative phase duration of the P in V₁ [PWDNV1]) and trans-thoracic echocardiography. Results were compared among both sexes and the control group. RESULTS In the study group, electrophysiological LAR was more advanced than in the control group, with significantly higher PWDI (80.60(±23.05) vs 62.49(±14.92) ms; p<0.001) and lower percentage of patients with normal Pmax/PWTFV1/PWDNV1/PWDI indices (2.73 vs 11.43%; p<0.05) respectively. LA area was larger (28.33(±7.50) vs 21.26(±2.79) cm²; p<0.001) and LVEF was lower (54.85(±9.14) vs 58.17(±6.40); p<0.05) in the study group compared to the control group. PWTF (4801.6(±3695.4) vs 4127.8(±3689.6) mcV*ms; p=0.049) was higher in males than in females. In multivariable logistic regression analysis, predictors significantly associated with IS occurrence in patients with AF were: higher PWDV₁ values (95% CI: 1.02-1.08, p<0.001), Pmax (95% CI: 0.90-0.97, p<0.001), and LVEF (95% CI: 0.84-0.99, p=0.030). CONCLUSIONS In patients with IS, higher indices of both structural and electrophysiological LAR are observed. There are significant differences between the sexes in the severity of LAR indices.