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

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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.

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