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Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients
BACKGROUND: Atrial fibrillation (AF) is a known risk factor for ischemic stroke. Electrocardiographic predictors of AF in population studies such as the Framingham Heart Study, as well as in hypertensive patients have demonstrated a predictive value of the P-wave duration for development of AF. QRS...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525302/ https://www.ncbi.nlm.nih.gov/pubmed/28738786 http://dx.doi.org/10.1186/s12872-017-0631-1 |
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author | Cortez, Daniel Baturova, Maria Lindgren, Arne Carlson, Jonas Shubik, Yuri V. Olsson, Bertil Platonov, Pyotr G. |
author_facet | Cortez, Daniel Baturova, Maria Lindgren, Arne Carlson, Jonas Shubik, Yuri V. Olsson, Bertil Platonov, Pyotr G. |
author_sort | Cortez, Daniel |
collection | PubMed |
description | BACKGROUND: Atrial fibrillation (AF) is a known risk factor for ischemic stroke. Electrocardiographic predictors of AF in population studies such as the Framingham Heart Study, as well as in hypertensive patients have demonstrated a predictive value of the P-wave duration for development of AF. QRS vector magnitude has had a predictive value in ventricular arrhythmia development. We aimed to assess the value of the three-dimensional P-wave vector magnitude and its relationship to P-wave duration for prediction of new-onset AF after ischemic stroke. METHODS: First-ever ischemic stroke patients without AF at inclusion in the Lund Stroke Register were included. Measurements of P wave duration (Pd), QRS duration, corrected QT interval, and PQ interval were performed automatically using the University of Glasgow 12-lead ECG analysis algorithm. The P-wave vector magnitude (Pvm) was calculated automatically as the square root of the sum of the squared P-wave magnitudes in leads V6, II and one half of the P-wave amplitude in V2 ([Formula: see text] ), based on the P-wave magnitude (Pvm) as defined by the visually transformed Kors’ Quasi-orthogonal method. RESULTS: The median age was 73 (IQR 63–80) years at stroke onset (135 males, 92 females). Multivariate predictors of new-onset atrial fibrillation included age > 65 years, hypertension, and Pd/Pvm. A cut-off value of 870 ms/mV gave sensitivity, specificity, positive and negative predictive values of 51, 79, 30 and 87%, respectively. The Pd/Pvm was the only ECG predictor of AF with a significant multivariate hazard ratio of 2.02 (95% CI 1.18 to 3.46, p = 0.010). CONCLUSION: P-wave dispersion as measured by the Pd/Pvm was the only ECG parameter measured which independently predicted subsequent AF identification in a cohort of stroke patients. Further prospective studies in larger cohorts are needed to validate its clinical usefulness. |
format | Online Article Text |
id | pubmed-5525302 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-55253022017-07-26 Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients Cortez, Daniel Baturova, Maria Lindgren, Arne Carlson, Jonas Shubik, Yuri V. Olsson, Bertil Platonov, Pyotr G. BMC Cardiovasc Disord Research Article BACKGROUND: Atrial fibrillation (AF) is a known risk factor for ischemic stroke. Electrocardiographic predictors of AF in population studies such as the Framingham Heart Study, as well as in hypertensive patients have demonstrated a predictive value of the P-wave duration for development of AF. QRS vector magnitude has had a predictive value in ventricular arrhythmia development. We aimed to assess the value of the three-dimensional P-wave vector magnitude and its relationship to P-wave duration for prediction of new-onset AF after ischemic stroke. METHODS: First-ever ischemic stroke patients without AF at inclusion in the Lund Stroke Register were included. Measurements of P wave duration (Pd), QRS duration, corrected QT interval, and PQ interval were performed automatically using the University of Glasgow 12-lead ECG analysis algorithm. The P-wave vector magnitude (Pvm) was calculated automatically as the square root of the sum of the squared P-wave magnitudes in leads V6, II and one half of the P-wave amplitude in V2 ([Formula: see text] ), based on the P-wave magnitude (Pvm) as defined by the visually transformed Kors’ Quasi-orthogonal method. RESULTS: The median age was 73 (IQR 63–80) years at stroke onset (135 males, 92 females). Multivariate predictors of new-onset atrial fibrillation included age > 65 years, hypertension, and Pd/Pvm. A cut-off value of 870 ms/mV gave sensitivity, specificity, positive and negative predictive values of 51, 79, 30 and 87%, respectively. The Pd/Pvm was the only ECG predictor of AF with a significant multivariate hazard ratio of 2.02 (95% CI 1.18 to 3.46, p = 0.010). CONCLUSION: P-wave dispersion as measured by the Pd/Pvm was the only ECG parameter measured which independently predicted subsequent AF identification in a cohort of stroke patients. Further prospective studies in larger cohorts are needed to validate its clinical usefulness. BioMed Central 2017-07-24 /pmc/articles/PMC5525302/ /pubmed/28738786 http://dx.doi.org/10.1186/s12872-017-0631-1 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Cortez, Daniel Baturova, Maria Lindgren, Arne Carlson, Jonas Shubik, Yuri V. Olsson, Bertil Platonov, Pyotr G. Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients |
title | Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients |
title_full | Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients |
title_fullStr | Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients |
title_full_unstemmed | Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients |
title_short | Atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients |
title_sort | atrial time and voltage dispersion are both needed to predict new-onset atrial fibrillation in ischemic stroke patients |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525302/ https://www.ncbi.nlm.nih.gov/pubmed/28738786 http://dx.doi.org/10.1186/s12872-017-0631-1 |
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