TY - JOUR
T1 - Association between P wave polarity in atrial premature complexes and cardiovascular events in a community-dwelling population
AU - Kabutoya, Tomoyuki
AU - Imai, Yasushi
AU - Ishikawa, Shizukiyo
AU - Kario, Kazuomi
N1 - Publisher Copyright:
©
PY - 2020/11/4
Y1 - 2020/11/4
N2 - Objective To examine the association between polarity of atrial premature complexes (APCs) and stroke. Design A prospective study. Setting and participants A total of 11 092 participants in the Jichi Medical School cohort study were included after excluding patients with atrial fibrillation. We analysed stroke events in patients with (n=136) and without (n=10 956) APCs. With regard to polarity of APCs, patients were subcategorised into having (1) negative (n=39) or non-negative (n=97) P waves in augmented vector right (aVR), and (2) positive (n=28) or non-positive (n=108) P waves in augmented vector left (aVL). Outcome measures The primary endpoint was stroke. Results Patients with APCs were significantly older than those without APCs (64.1±9.2 vs 55.1±11.6 years, p<0.001). The mean follow-up period was 11.8±2.4 years. Stroke events were observed in patients with (n=13 events) and without (n=411 events) APCs. This difference was significant (log-rank 12.9, p<0.001); however, APCs were not an independent predictor of stroke after adjusting for age, sex, height, body mass index, current drinking, diabetes, systolic blood pressure, prior myocardial infarction, prior stroke and high-density lipoprotein-cholesterol (p=0.15). The incidence of stroke in patients with APCs and non-negative P wave in aVR was significantly higher than in patients without APCs (log-rank 20.1, p<0.001), and non-negative P wave in aVR was revealed to be an independent predictor of stroke (HR 1.84, 95% CI 1.02 to 3.30). The incidence of stroke in patients with APC with non-positive P wave in aVL was also significantly higher than in patients without APC (log-rank 15.3, p<0.001), and non-positive P wave in aVL was an independent predictor of stroke (HR 1.92, 95% CI 1.05 to 3.54). Conclusions The presence of APCs with non-negative P wave in aVR or non-positive P wave in aVL on 12-lead ECG was associated with a higher risk of incident stroke.
AB - Objective To examine the association between polarity of atrial premature complexes (APCs) and stroke. Design A prospective study. Setting and participants A total of 11 092 participants in the Jichi Medical School cohort study were included after excluding patients with atrial fibrillation. We analysed stroke events in patients with (n=136) and without (n=10 956) APCs. With regard to polarity of APCs, patients were subcategorised into having (1) negative (n=39) or non-negative (n=97) P waves in augmented vector right (aVR), and (2) positive (n=28) or non-positive (n=108) P waves in augmented vector left (aVL). Outcome measures The primary endpoint was stroke. Results Patients with APCs were significantly older than those without APCs (64.1±9.2 vs 55.1±11.6 years, p<0.001). The mean follow-up period was 11.8±2.4 years. Stroke events were observed in patients with (n=13 events) and without (n=411 events) APCs. This difference was significant (log-rank 12.9, p<0.001); however, APCs were not an independent predictor of stroke after adjusting for age, sex, height, body mass index, current drinking, diabetes, systolic blood pressure, prior myocardial infarction, prior stroke and high-density lipoprotein-cholesterol (p=0.15). The incidence of stroke in patients with APCs and non-negative P wave in aVR was significantly higher than in patients without APCs (log-rank 20.1, p<0.001), and non-negative P wave in aVR was revealed to be an independent predictor of stroke (HR 1.84, 95% CI 1.02 to 3.30). The incidence of stroke in patients with APC with non-positive P wave in aVL was also significantly higher than in patients without APC (log-rank 15.3, p<0.001), and non-positive P wave in aVL was an independent predictor of stroke (HR 1.92, 95% CI 1.05 to 3.54). Conclusions The presence of APCs with non-negative P wave in aVR or non-positive P wave in aVL on 12-lead ECG was associated with a higher risk of incident stroke.
KW - P-wave
KW - atrial premature complexes
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85095675373&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2019-033553
DO - 10.1136/bmjopen-2019-033553
M3 - Article
C2 - 33148719
AN - SCOPUS:85095675373
SN - 2044-6055
VL - 10
JO - BMJ Open
JF - BMJ Open
IS - 11
M1 - e033553
ER -