title: Prolonged P wave duration predicts stroke mortality among type 2 diabetic patients with prevalent non-major macrovascular disease.
abstract: BACKGROUND
  Prolonged P wave duration is a marker of delayed inter-atrial conduction which may predict cardiovascular disease (CVD). Type 2 diabetes is a risk factor for all atherosclerotic manifestations including stroke. We evaluated the prognostic significance of prolonged P wave duration among middle-aged Finnish type 2 diabetes patients with and without prevalent non-major macrovascular disease (PNMMVD) with respect to total and stroke mortality.
  
  
  METHODS
  We followed up for 18 years 739 type 2 diabetic patients without previous major CVD event at baseline. Participants were stratified according to P wave duration (<114 or ≥ 114 ms) and PNMMVD (i.e. coronary heart disease defined as ischaemic ECG changes and typical symptoms of angina pectoris, or claudication; yes or no). The Cox proportional hazards model was used to estimate the joint association between P wave duration, PNMMVD and the mortality risk.
  
  
  RESULTS
  During the follow-up, 509 patients died, and 59 of them died from stroke. Those who had prolonged P wave duration had 2.45 (95% confidence interval: 1.11-5.37) increased stroke mortality among PNMMVD patients. In patients without PNMMVD, there was no relationship between P wave duration and stroke mortality.
  
  
  CONCLUSIONS
  As an easily measurable factor P wave duration merits further studies with higher number of patients to evaluate its importance in the estimation of stroke risk in type 2 diabetic patients with PNMMVD.
authors.affiliation: Department of Medicine, University of Turku and Turku University Hospital, Kiinamyllynkatu 10, 20520 Turku, Finland. tkveps@utu.fi.
authors.forename: Teemu
authors.initials: T
authors.lastname: Vepsäläinen
authors.forename: Markku
authors.initials: M
authors.lastname: Laakso
authors.forename: Seppo
authors.initials: S
authors.lastname: Lehto
authors.forename: Auni
authors.initials: A
authors.lastname: Juutilainen
authors.forename: Juhani
authors.initials: J
authors.lastname: Airaksinen
authors.forename: Tapani
authors.initials: T
authors.lastname: Rönnemaa
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000401:mortality*