P-Wave Indices and Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis

Jinli He; Gary Tse; Panagiotis Korantzopoulos; Konstantinos P Letsas; Sadeq Ali-Hasan-Al-Saegh; Hooman Kamel; Guangping Li; Gregory Y H Lip; Tong Liu

doi:10.1161/STROKEAHA.117.017293

P-Wave Indices and Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis

Jinli He, Gary Tse, Panagiotis Korantzopoulos, Konstantinos P Letsas, Sadeq Ali-Hasan-Al-Saegh, Hooman Kamel, Guangping Li, Gregory Y H Lip, Tong Liu

Research output: Contribution to journal › Review article › peer-review

99 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE: Atrial cardiomyopathy is associated with an increased risk of ischemic stroke. P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are electrocardiographic parameters that have been used to assess left atrial abnormalities related to developing atrial fibrillation. The aim of this systematic review and meta-analysis was to examine their values for predicting ischemic stroke risk.

METHODS: PubMed and EMBASE databases were searched until December 2016 for studies that evaluated the association between P-wave indices and stroke risk. Both fixed- and random-effects models were used to calculate the overall effect estimates.

RESULTS: Ten studies examining P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area were included. P-wave terminal force in lead V1 was found to be an independent predictor of stroke as both a continuous variable (odds ratio [OR] per 1 SD change, 1.18; 95% confidence interval [CI], 1.12-1.25; P<0.0001) and categorical variable (OR, 1.59; 95% CI, 1.10-2.28; P=0.01). P-wave duration was a significant predictor of incident ischemic stroke when analyzed as a categorical variable (OR, 1.86; 95% CI, 1.37-2.52; P<0.0001) but not when analyzed as a continuous variable (OR, 1.05; 95% CI, 0.98-1.13; P=0.15). Maximum P-wave area also predicted the risk of incident ischemic stroke (OR per 1 SD change, 1.10; 95% CI, 1.04-1.17).

CONCLUSIONS: P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are useful electrocardiographic markers that can be used to stratify the risk of incident ischemic stroke.

Original language	English
Journal	Stroke
Volume	48
Issue number	8
Pages (from-to)	2066-2072
Number of pages	7
ISSN	0039-2499
DOIs	https://doi.org/10.1161/STROKEAHA.117.017293
Publication status	Published - 2017

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This article has been found as a 'Free Version' from the Publisher on July 26th 2018. When the access to the article closes, please notify vbn@aub.aau.dk”

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Journal Article

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10.1161/STROKEAHA.117.017293

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title = "P-Wave Indices and Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis",

abstract = "BACKGROUND AND PURPOSE: Atrial cardiomyopathy is associated with an increased risk of ischemic stroke. P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are electrocardiographic parameters that have been used to assess left atrial abnormalities related to developing atrial fibrillation. The aim of this systematic review and meta-analysis was to examine their values for predicting ischemic stroke risk.METHODS: PubMed and EMBASE databases were searched until December 2016 for studies that evaluated the association between P-wave indices and stroke risk. Both fixed- and random-effects models were used to calculate the overall effect estimates.RESULTS: Ten studies examining P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area were included. P-wave terminal force in lead V1 was found to be an independent predictor of stroke as both a continuous variable (odds ratio [OR] per 1 SD change, 1.18; 95% confidence interval [CI], 1.12-1.25; P<0.0001) and categorical variable (OR, 1.59; 95% CI, 1.10-2.28; P=0.01). P-wave duration was a significant predictor of incident ischemic stroke when analyzed as a categorical variable (OR, 1.86; 95% CI, 1.37-2.52; P<0.0001) but not when analyzed as a continuous variable (OR, 1.05; 95% CI, 0.98-1.13; P=0.15). Maximum P-wave area also predicted the risk of incident ischemic stroke (OR per 1 SD change, 1.10; 95% CI, 1.04-1.17).CONCLUSIONS: P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are useful electrocardiographic markers that can be used to stratify the risk of incident ischemic stroke.",

keywords = "Journal Article",

author = "Jinli He and Gary Tse and Panagiotis Korantzopoulos and Letsas, {Konstantinos P} and Sadeq Ali-Hasan-Al-Saegh and Hooman Kamel and Guangping Li and Lip, {Gregory Y H} and Tong Liu",

note = "This article has been found as a 'Free Version' from the Publisher on July 26th 2018. When the access to the article closes, please notify vbn@aub.aau.dk”",

year = "2017",

doi = "10.1161/STROKEAHA.117.017293",

language = "English",

volume = "48",

pages = "2066--2072",

journal = "Stroke",

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TY - JOUR

T1 - P-Wave Indices and Risk of Ischemic Stroke

T2 - A Systematic Review and Meta-Analysis

AU - He, Jinli

AU - Tse, Gary

AU - Korantzopoulos, Panagiotis

AU - Letsas, Konstantinos P

AU - Ali-Hasan-Al-Saegh, Sadeq

AU - Kamel, Hooman

AU - Li, Guangping

AU - Lip, Gregory Y H

AU - Liu, Tong

N1 - This article has been found as a 'Free Version' from the Publisher on July 26th 2018. When the access to the article closes, please notify vbn@aub.aau.dk”

PY - 2017

Y1 - 2017

N2 - BACKGROUND AND PURPOSE: Atrial cardiomyopathy is associated with an increased risk of ischemic stroke. P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are electrocardiographic parameters that have been used to assess left atrial abnormalities related to developing atrial fibrillation. The aim of this systematic review and meta-analysis was to examine their values for predicting ischemic stroke risk.METHODS: PubMed and EMBASE databases were searched until December 2016 for studies that evaluated the association between P-wave indices and stroke risk. Both fixed- and random-effects models were used to calculate the overall effect estimates.RESULTS: Ten studies examining P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area were included. P-wave terminal force in lead V1 was found to be an independent predictor of stroke as both a continuous variable (odds ratio [OR] per 1 SD change, 1.18; 95% confidence interval [CI], 1.12-1.25; P<0.0001) and categorical variable (OR, 1.59; 95% CI, 1.10-2.28; P=0.01). P-wave duration was a significant predictor of incident ischemic stroke when analyzed as a categorical variable (OR, 1.86; 95% CI, 1.37-2.52; P<0.0001) but not when analyzed as a continuous variable (OR, 1.05; 95% CI, 0.98-1.13; P=0.15). Maximum P-wave area also predicted the risk of incident ischemic stroke (OR per 1 SD change, 1.10; 95% CI, 1.04-1.17).CONCLUSIONS: P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are useful electrocardiographic markers that can be used to stratify the risk of incident ischemic stroke.

AB - BACKGROUND AND PURPOSE: Atrial cardiomyopathy is associated with an increased risk of ischemic stroke. P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are electrocardiographic parameters that have been used to assess left atrial abnormalities related to developing atrial fibrillation. The aim of this systematic review and meta-analysis was to examine their values for predicting ischemic stroke risk.METHODS: PubMed and EMBASE databases were searched until December 2016 for studies that evaluated the association between P-wave indices and stroke risk. Both fixed- and random-effects models were used to calculate the overall effect estimates.RESULTS: Ten studies examining P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area were included. P-wave terminal force in lead V1 was found to be an independent predictor of stroke as both a continuous variable (odds ratio [OR] per 1 SD change, 1.18; 95% confidence interval [CI], 1.12-1.25; P<0.0001) and categorical variable (OR, 1.59; 95% CI, 1.10-2.28; P=0.01). P-wave duration was a significant predictor of incident ischemic stroke when analyzed as a categorical variable (OR, 1.86; 95% CI, 1.37-2.52; P<0.0001) but not when analyzed as a continuous variable (OR, 1.05; 95% CI, 0.98-1.13; P=0.15). Maximum P-wave area also predicted the risk of incident ischemic stroke (OR per 1 SD change, 1.10; 95% CI, 1.04-1.17).CONCLUSIONS: P-wave terminal force in lead V1, P-wave duration, and maximum P-wave area are useful electrocardiographic markers that can be used to stratify the risk of incident ischemic stroke.

KW - Journal Article

UR - https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.117.017293

U2 - 10.1161/STROKEAHA.117.017293

DO - 10.1161/STROKEAHA.117.017293

M3 - Review article

C2 - 28679858

SN - 0039-2499

VL - 48

SP - 2066

EP - 2072

JO - Stroke

JF - Stroke

IS - 8

ER -

P-Wave Indices and Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis

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