. 2018 Apr;49(4):980-986.

doi: 10.1161/STROKEAHA.117.020059. Epub 2018 Mar 13.

Atrial Cardiopathy and the Risk of Ischemic Stroke in the CHS (Cardiovascular Health Study)

Affiliations

¹ From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Department of Medicine (K.K.P., W.T.L.), Department of Epidemiology, Cardiovascular Health Research Unit (S.R.H.), Department of Biostatistics, Collaborative Health Studies Coordinating Center (R.A.K.), Department of Neurology (W.T.L.), and Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.) and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (P.K.S.); Inova Heart and Vascular Institute, Falls Church, VA (C.d.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); and Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.). hok9010@med.cornell.edu.
² From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Department of Medicine (K.K.P., W.T.L.), Department of Epidemiology, Cardiovascular Health Research Unit (S.R.H.), Department of Biostatistics, Collaborative Health Studies Coordinating Center (R.A.K.), Department of Neurology (W.T.L.), and Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.) and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (P.K.S.); Inova Heart and Vascular Institute, Falls Church, VA (C.d.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); and Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).

PMID: 29535268
PMCID: PMC5973804
DOI: 10.1161/STROKEAHA.117.020059

Atrial Cardiopathy and the Risk of Ischemic Stroke in the CHS (Cardiovascular Health Study)

Hooman Kamel et al. Stroke. 2018 Apr.

. 2018 Apr;49(4):980-986.

doi: 10.1161/STROKEAHA.117.020059. Epub 2018 Mar 13.

Affiliations

¹ From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Department of Medicine (K.K.P., W.T.L.), Department of Epidemiology, Cardiovascular Health Research Unit (S.R.H.), Department of Biostatistics, Collaborative Health Studies Coordinating Center (R.A.K.), Department of Neurology (W.T.L.), and Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.) and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (P.K.S.); Inova Heart and Vascular Institute, Falls Church, VA (C.d.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); and Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.). hok9010@med.cornell.edu.
² From the Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York, NY; Department of Biostatistics (T.M.B.), Department of Medicine (K.K.P., W.T.L.), Department of Epidemiology, Cardiovascular Health Research Unit (S.R.H.), Department of Biostatistics, Collaborative Health Studies Coordinating Center (R.A.K.), Department of Neurology (W.T.L.), and Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Neurology, College of Physicians and Surgeons (M.S.V.E.) and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University, New York, NY; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Cardiovascular Division, Washington University School of Medicine, St. Louis, MO (P.K.S.); Inova Heart and Vascular Institute, Falls Church, VA (C.d.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); and Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).

PMID: 29535268
PMCID: PMC5973804
DOI: 10.1161/STROKEAHA.117.020059

Abstract

Background and purpose: Emerging evidence suggests that an underlying atrial cardiopathy may result in thromboembolism before atrial fibrillation (AF) develops. We examined the association between various markers of atrial cardiopathy and the risk of ischemic stroke.

Methods: The CHS (Cardiovascular Health Study) prospectively enrolled community-dwelling adults ≥65 years of age. For this study, we excluded participants diagnosed with stroke or AF before baseline. Exposures were several markers of atrial cardiopathy: baseline P-wave terminal force in ECG lead V₁, left atrial dimension on echocardiogram, and N terminal pro B type natriuretic peptide (NT-proBNP), as well as incident AF. Incident AF was ascertained from 12-lead electrocardiograms at annual study visits for the first decade after study enrollment and from inpatient and outpatient Medicare data throughout follow-up. The primary outcome was incident ischemic stroke. We used Cox proportional hazards models that included all 4 atrial cardiopathy markers along with adjustment for demographic characteristics and established vascular risk factors.

Results: Among 3723 participants who were free of stroke and AF at baseline and who had data on all atrial cardiopathy markers, 585 participants (15.7%) experienced an incident ischemic stroke during a median 12.9 years of follow-up. When all atrial cardiopathy markers were combined in 1 Cox model, we found significant associations with stroke for P-wave terminal force in ECG lead V₁ (hazard ratio per 1000 μV*ms 1.04; 95% confidence interval, 1.001-1.08), log-transformed NT-proBNP (hazard ratio per doubling of NT-proBNP, 1.09; 95% confidence interval, 1.03-1.16), and incident AF (hazard ratio, 2.04; 95% confidence interval, 1.67-2.48) but not left atrial dimension (hazard ratio per cm, 0.96; 95% confidence interval, 0.84-1.10).

Conclusions: In addition to clinically apparent AF, other evidence of abnormal atrial substrate is associated with subsequent ischemic stroke. This finding is consistent with the hypothesis that thromboembolism from the left atrium may occur in the setting of several different manifestations of atrial disease.

Keywords: adult; atrial fibrillation; cardiomyopathies; risk factors; thromboembolism.

PubMed Disclaimer

Cited by

Association of Intracranial Hemorrhage Risk With Non-Vitamin K Antagonist Oral Anticoagulant Use vs Aspirin Use: A Systematic Review and Meta-analysis.
Huang WY, Singer DE, Wu YL, Chiang CE, Weng HH, Lee M, Ovbiagele B. Huang WY, et al. JAMA Neurol. 2018 Dec 1;75(12):1511-1518. doi: 10.1001/jamaneurol.2018.2215. JAMA Neurol. 2018. PMID: 30105396 Free PMC article.
Prevalence of Nonstenotic Carotid Plaque in Stroke Due to Atrial Fibrillation Compared to Embolic Stroke of Undetermined Source.
Siegler JE, Thon JM, Woo JH, Do D, Messé SR, Cucchiara B. Siegler JE, et al. J Stroke Cerebrovasc Dis. 2019 Oct;28(10):104289. doi: 10.1016/j.jstrokecerebrovasdis.2019.07.005. Epub 2019 Jul 26. J Stroke Cerebrovasc Dis. 2019. PMID: 31353245 Free PMC article.
Association between excessive supraventricular ectopy and subclinical cerebrovascular disease: a population-based study.
Hisamatsu T, Miura K, Fujiyoshi A, Kunimura A, Ito T, Miyazawa I, Torii S, Shiino A, Nozaki K, Kanda H, Arima H, Ohkubo T, Ueshima H; Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA) Research Group. Hisamatsu T, et al. Eur J Neurol. 2019 Sep;26(9):1219-1225. doi: 10.1111/ene.13970. Epub 2019 May 9. Eur J Neurol. 2019. PMID: 31002446 Free PMC article.
Abnormal P-wave terminal force in lead V₁ is a marker for atrial electrical dysfunction but not structural remodelling.
Lebek S, Wester M, Pec J, Poschenrieder F, Tafelmeier M, Fisser C, Provaznik Z, Schopka S, Debl K, Schmid C, Buchner S, Maier LS, Arzt M, Wagner S. Lebek S, et al. ESC Heart Fail. 2021 Oct;8(5):4055-4066. doi: 10.1002/ehf2.13488. Epub 2021 Jun 30. ESC Heart Fail. 2021. PMID: 34196135 Free PMC article.
Impairment of left atrial function and cryptogenic stroke: Potential insights in the pathophysiology of stroke in the young.
Bhat A, Khanna S, Chen HH, Lee L, Gan GCH, Negishi K, MacIntyre CR, Nunes MCP, Tan TC. Bhat A, et al. Int J Cardiol Heart Vasc. 2019 Dec 26;26:100454. doi: 10.1016/j.ijcha.2019.100454. eCollection 2020 Feb. Int J Cardiol Heart Vasc. 2019. PMID: 31909178 Free PMC article.

See all "Cited by" articles

References

1. Marnane M, Duggan CA, Sheehan OC, Merwick A, Hannon N, Curtin D, et al. Stroke subtype classification to mechanism-specific and undetermined categories by TOAST, A-S-C-O, and Causative Classification system. Stroke. 2010;41:1579–1586. - PubMed
1. Hart RG, Diener HC, Coutts SB, Easton JD, Granger CB, O’Donnell MJ, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13:429–438. - PubMed
1. Sanna T, Diener HC, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med. 2014;370:2478–2486. - PubMed
1. Kamel H, Okin PM, Elkind MS, Iadecola C. Atrial fibrillation and mechanisms of stroke: time for a new model. Stroke. 2016;47:895–900. - PMC - PubMed
1. Kamel H, Healey JS. Cardioembolic stroke. Circ Res. 2017;120:514–526. - PMC - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Atrial Cardiopathy and the Risk of Ischemic Stroke in the CHS (Cardiovascular Health Study)

Affiliations

Atrial Cardiopathy and the Risk of Ischemic Stroke in the CHS (Cardiovascular Health Study)

Authors

Affiliations

Abstract

Similar articles

Cited by

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials

Abstract

Similar articles

Cited by

References

Publication types

MeSH terms

Substances

Related information

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials