Faculty Collaboration Database

Atrial cardiopathy and stroke mortality in the general population. Int J Stroke 2020 Aug;15(6):650-656

Date

09/19/2019

Pubmed ID

31530133

DOI

10.1177/1747493019876543

Scopus ID

2-s2.0-85074303210 (requires institutional sign-in at Scopus site)   11 Citations

Abstract

BACKGROUND: Prior studies examining the link between atrial cardiopathy and stroke risk have focused mainly on non-fatal stroke.

AIMS: To examine the association between atrial cardiopathy and stroke mortality.

METHODS: This analysis included 8028 participants (60.0 ± 13.4 years, 51.9% women, 49.8% white) from the Third National Health and Nutrition Examination (NHANES III) Survey. Atrial cardiopathy was defined as abnormal deep terminal negativity of the P wave in V1 (DTNPV1 = negative p-wave in V1<-100 µv), an electrocardiographic marker of atrial cardiopathy. Stroke mortality was ascertained using the National Death Index over a median follow-up of 14 years.

RESULTS: 2.95% (n = 237) of the participants had atrial cardiopathy, and the prevalence was slightly higher in blacks (4%) versus whites (3%). During follow-up, stroke mortality was more common in those with (5.9%) than those without (2.7%) atrial cardiopathy; p = .004. In a multivariable adjusted model, atrial cardiopathy was associated with a 76% increased risk of stroke mortality (HR (95% CI): 1.76 (1.02-3.04)]. This association was stronger in non-whites than whites (HR (95% CI): 3.50 (1.74-7.03) vs. 0.98 (0.40-2.42), respectively; interaction p = 0.03). Among those with baseline atrial cardiopathy, the annualized stroke mortality rates/1000 participants across CHA₂DS₂-VASc scores of 0, 1, and ≥2 were 0.0, 2.2, and 7.8, respectively.

CONCLUSIONS: Atrial cardiopathy is associated with an increased risk of stroke mortality, especially among non-whites. Among those with atrial cardiopathy, the risk of stroke mortality exponentially increases as the CHA₂DS₂-VASc score becomes 2 or above. Randomized controlled trials are needed to assess the efficacy of anticoagulation in the prevention of ischemic stroke and thus, stroke mortality in the presence of atrial cardiopathy.

Author List

Ahmad MI, Singleton MJ, Bhave PD, Kamel H, Soliman EZ

Author

Muhammad Imtiaz Ahmad MBBS Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Atrial Fibrillation
Biomarkers
Electrocardiography
Female
Heart Diseases
Humans
Male
Nutrition Surveys
Risk Assessment
Risk Factors
Stroke