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. 2015 Jan;169(1):53-61.e1.
doi: 10.1016/j.ahj.2014.10.009. Epub 2014 Oct 22.

P-wave indices and atrial fibrillation: cross-cohort assessments from the Framingham Heart Study (FHS) and Atherosclerosis Risk in Communities (ARIC) study

Jared W Magnani  1 , Lei Zhu  2 , Faye Lopez  3 , Michael J Pencina  4 , Sunil K Agarwal  5 , Elsayed Z Soliman  6 , Emelia J Benjamin  7 , Alvaro Alonso  3
Affiliations

P-wave indices and atrial fibrillation: cross-cohort assessments from the Framingham Heart Study (FHS) and Atherosclerosis Risk in Communities (ARIC) study

Jared W Magnani et al. Am Heart J. 2015 Jan.

Abstract

Background: Atrial fibrillation (AF) is associated with increased morbidity. P-wave indices (PWIs) measure atrial electrical function and are associated with AF. Study of PWI has been limited to single-cohort investigations, and their contributions to risk enhancement are unknown.

Methods: We examined PWI from the FHS and ARIC study. We calculated 10-year AF risk using adjusted Cox models. We conducted cross-cohort meta-analyses for the PWI estimates and assessed their contributions to risk discrimination (c statistic), net reclassification index, and integrated discrimination improvement.

Results: After exclusions, the analysis included 3,110 FHS (62.6 ± 9.8 years, 56.9% women) and 8,254 ARIC participants (62.3 ± 5.6 years, 57.3% women, 20.3% black race). Over 10 years, 217 FHS and 458 ARIC participants developed AF. In meta-analysis, P-wave duration >120 milliseconds was significantly associated with AF (hazard ratio 1.55, 95% CI 1.29-1.85) compared with ≤120 milliseconds. P-wave area was marginally but not significantly related to AF (hazard ratio 1.31, 95% CI 0.95-1.80). P-wave terminal force was strongly associated with AF in ARIC but not FHS. P-wave indices had a limited contribution toward predictive risk beyond traditional risk factors and markers.

Conclusions: P-wave indices are intermediate phenotypes for AF. They are associated with AF in cross-cohort meta-analyses but contribute minimally toward enhancing risk prediction.

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Conflict of interest statement

Disclosures

The authors have no disclosures or conflicts of interest to report.

Figures

Figure 1
Figure 1
Cross-cohort meta-analysis for the 10-year risk of incident atrial fibrillation in the FHS (Framingham Heart Study) and the Atherosclerosis Risk in Communities (ARIC) Study cohorts. Hazard ratios (95% Confidence Intervals) are shown for each cohort. Results are adjusted for age, sex and race (in ARIC) and multivariable-adjusted as per text. The I-squared presents the heterogeneity index for meta-analysis across the two cohorts.
Figure 2
Figure 2
Restricted cubic splines illustrating the associations between the P-wave indices and the relative hazard for atrial fibrillation (AF) during 10-year follow-up (2A, Framingham Heart Study; 2B, Atherosclerosis Risk in Communities Study). Models adjusted for age, sex, and race (in ARIC).
Figure 2
Figure 2
Restricted cubic splines illustrating the associations between the P-wave indices and the relative hazard for atrial fibrillation (AF) during 10-year follow-up (2A, Framingham Heart Study; 2B, Atherosclerosis Risk in Communities Study). Models adjusted for age, sex, and race (in ARIC).
See this image and copyright information in PMC

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