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 - Funding Information:
Funding This study was supported by Grants-in-Aid 13470096, 15390209 and 18390198 from the Ministry of Education, Culture, Sports, Science and Technology, Japan. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests TK has received scholarship funding from Mitsubishi Tanabe Pharma. KK has received research grants from A&D, Omron Healthcare, Roche Diagnostics KK, MSD KK, Astellas Pharma, Otsuka Holdings, Otsuka Pharmaceutical, Sanofi KK, Shionogi & Co, Sanwa Kagaku Kenkyusho, Daiichi Sankyo, Sumitomo Dainippon Pharma, Takeda Pharmaceutical, Mitsubishi Tanabe Pharma, Teijin Pharma, Boehringer Ingelheim Japan, Pfizer Japan and Fukuda Denshi.
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 -