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. 2024 May-Jun:84:123-128.
doi: 10.1016/j.jelectrocard.2024.03.016. Epub 2024 Apr 17.

Deep terminal negative of the P wave in V1 and incidence of ischemic stroke: The atherosclerosis risk in communities (ARIC) study

Mingfang Li  1 , Yuekai Ji  2 , Youmei Shen  1 , Wendy Wang  3 , Kamakshi Lakshminarayan  4 , Elsayed Z Soliman  5 , Minglong Chen  1 , Lin Yee Chen  6
Affiliations

Deep terminal negative of the P wave in V1 and incidence of ischemic stroke: The atherosclerosis risk in communities (ARIC) study

Mingfang Li et al. J Electrocardiol. 2024 May-Jun.

Abstract

Background: Deep terminal negative of the P wave in V1 (DTNPV1) is a marker of left atrial remodeling. We aimed to evaluate the association of DTNPV1 with incident ischemic stroke.

Methods: The Atherosclerosis Risk in Communities study is a prospective community-based cohort study. All participants at visit 4 (1996-1998) except those with prevalent stroke, missing covariates, and missing or uninterpretable ECG were included. DTNPV1 was defined as the absolute value of the depth of the terminal negative phase >100 μV in the presence of biphasic P wave in V1. Association between DTNPV1 as a time-dependent exposure variable and incident ischemic stroke was evaluated. The accuracy of the prediction model consisting of DTNPV1 and CHA2DS2-VASc variables in predicting ischemic stroke was analyzed.

Results: Among 10,605 participants (63 ± 6 years, 56% women, 20% Black), 803 cases of ischemic stroke occurred over a median follow-up of 20.19 years. After adjusting for demographics, DTNPV1 was associated with an increased risk of stroke (HR 1.96, [95% CI 1.39-2.77]). After further adjusting for stroke risk factors, use of aspirin and anticoagulants, and time-dependent atrial fibrillation, DTNPV1 was associated with a 1.50-fold (95% CI 1.06-2.13) increased risk of stroke. When added to the CHA2DS2-VASc variables, DTNPV1 did not significantly improve stroke prediction as assessed by C-statistic. However, there was improvement in risk classification for participants who did not develop stroke.

Conclusion: DTNPV1 is significantly associated with higher risk of ischemic stroke. Since DTNPV1 is a simplified electrocardiographic parameter, it may help stroke prediction, a subject for further research.

Keywords: Atrial fibrillation; Electrocardiography; Ischemic stroke; P wave.

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Conflict of interest statement

Declaration of competing interest None.

Figures

Figure 1.
Figure 1.
Flow of study participants. ARIC study, followed up through 2019 (except for Jackson field center, which ended on December 31, 2017). For this analysis, visit 4 (1996–1998) served as the baseline.
Figure 2.
Figure 2.
Schematic illustration of terminal negativity of P-wave in lead V1.
Figure 3.
Figure 3.
Association between baseline (ARIC visit 4, 1996–1998) amplitude of the terminal negative phase of P wave in V1 and ischemic stroke modeled using an unadjusted restricted cubic spline. ARIC=Atherosclerosis Risk in Communities.
See this image and copyright information in PMC

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