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P-Wave Indices and the Risks of Incident Atrial Fibrillation and Ischemic Stroke in Black Adults: The Jackson Heart
Vidhushei Yogeswaran1,2, Kerri L Wiggins1,2, Colleen M Sitlani1,2
1Cardiovascular Health Research Unit University of Washington Seattle Washington USA.
Insights
P-wave indices (PWIs) like PTFV1 indicate atrial cardiomyopathy and predict atrial fibrillation (AF) and stroke risk in Black adults. These ECG measures are vital for assessing cardiovascular risk in this population.
Area of Science:
- Cardiology
- Electrophysiology
- Public Health
Background:
- Atrial cardiomyopathy, characterized by atrial changes, is a growing risk factor for atrial fibrillation (AF).
- Black adults face a higher burden of AF complications, yet atrial cardiomyopathy's impact on outcomes in this group is understudied.
- Electrocardiogram (ECG)-derived P-wave indices (PWIs) are emerging markers for atrial cardiomyopathy.
Purpose of the Study:
- To investigate the association between PWIs and the risk of incident atrial fibrillation (AF) and ischemic stroke in Black adults.
- To determine if specific PWIs, such as P-wave terminal force in V1 (PTFV1), are independent predictors of AF and stroke in this population.
Main Methods:
- Analysis of 4900 Black adults without AF from the Jackson Heart Study (JHS) cohort.
- Assessment of atrial cardiomyopathy using resting 12-lead ECGs, measuring PR interval, P-wave duration, P-wave axis, and PTFV1.
- Cox proportional hazards models used to evaluate associations between PWIs and incident AF/ischemic stroke, adjusting for risk factors.
Main Results:
- Over 13.7 years, 9.3% developed AF and 3.8% had ischemic stroke.
- Increased PR interval, P-wave duration, and PTFV1 were linked to higher AF risk; PTFV1 showed the strongest association (HR 1.27).
- Higher PTFV1 also correlated with a 22% increased risk of ischemic stroke (HR 1.22).
Conclusions:
- PWIs, especially PTFV1, are independently associated with increased risks of incident AF and ischemic stroke in Black adults.
- PTFV1 serves as a significant indicator of atrial cardiomyopathy in this demographic.
- These findings highlight the clinical utility of ECG-based PWIs for risk stratification in Black adults.
Background:
Atrial cardiomyopathy, defined as adverse changes to the cardiac atria, is an emerging risk factor for atrial fibrillation (AF). Despite the disproportionate burden of AF-related complications in Black adults, the relationship between electrocardiographic (ECG) measures of atrial cardiomyopathy, referred to as P-wave indices (PWIs), and outcomes remains largely unknown in this population.
Methods:
In 4900 participants without AF at baseline from the JHS (Jackson Heart Study), a prospective cohort study of Black adults, we assessed atrial cardiomyopathy using PWIs from resting 12-lead ECGs: PR interval, P-wave duration, P-wave axis, and P-wave terminal force in V1 (PTFV1). Cox proportional hazards models evaluated associations of PWIs with incident AF and ischemic stroke, adjusting for established risk factors.
Results:
Over 13.7 years of follow-up, 396 (9.3%) participants developed incident AF, and 135 (3.8%) experienced ischemic stroke. Each SD-unit increase in PR interval, P-wave duration, and PTFV1 was associated with increased AF risk, with the strongest association for PTFV1 (hazard ratio [HR], 1.27 [95% CI, 1.16-1.38]). These PWIs were also associated with AF risk using clinically accepted thresholds, including HR of 1.76 for PTFV1 ≥4000 ms×μV (95%CI, 1.38-2.25). Each SD increase in PTFV1 was associated with a 22% increased risk of ischemic stroke (HR, 1.22 [95% CI, 1.07-1.40]).
Conclusions:
In this large cohort study of Black adults, PWIs, particularly PTFV1, were independently associated with an increased risk of incident AF and ischemic stroke. These findings underscore the significance of PTFV1 as an underlying marker of atrial cardiomyopathy in Black adults.
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