title: Association between left atrial abnormality on ECG and vascular brain injury on MRI in the Cardiovascular Health Study.
abstract: OBJECTIVE
  Emerging evidence suggests that atrial disease is associated with vascular brain injury in the absence of atrial fibrillation.
  
  
  METHODS
  The Cardiovascular Health Study prospectively enrolled community-dwelling adults aged ≥65 years. Among participants who underwent MRI, we examined associations of ECG left atrial abnormality with brain infarcts and leukoaraiosis. P-wave terminal force in lead V1 was the primary measure of left atrial abnormality; P-wave area and duration were secondary predictors. We excluded participants with atrial fibrillation before or on their index ECG. Primary outcomes were incident infarcts and worsening leukoaraiosis from initial to follow-up scan ≈5 years later. Secondary outcomes were prevalent infarcts and degree of leukoaraiosis on initial MRI. Relative risk (RR) and linear regression models were adjusted for vascular risk factors.
  
  
  RESULTS
  Among 3129 participants with ≥1 scan, each SD increase in P-wave terminal force in lead V1 was associated with a 0.05-point (95% confidence interval [CI], 0.0003-0.10) higher baseline white matter grade on a 10-point scale. P-wave terminal force in lead V1 was associated with prevalent infarcts of any type (RR per SD, 1.09; 95% CI, 1.04-1.16) and more so with prevalent nonlacunar infarcts (RR per SD, 1.22; 95% CI, 1.08-1.38). Among 1839 participants with 2 scans, P-wave terminal force in lead V1 was associated with worsening leukoaraiosis (RR per SD, 1.09; 95% CI, 1.01-1.18), but not with incident infarcts (RR per SD, 1.06; 95% CI, 0.93-1.20). Sensitivity analyses adjusting for incident atrial fibrillation found similar results. P-wave area and duration were not associated with outcomes.
  
  
  CONCLUSIONS
  ECG left atrial abnormality is associated with vascular brain injury in the absence of documented atrial fibrillation.
authors: From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.). hok9010@med.cornell.edu.
authors: Hooman
authors: H
authors: Kamel
authors: From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
authors: Traci M
authors: TM
authors: Bartz
authors: From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
authors: W T
authors: WT
authors: Longstreth
authors: From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
authors: Peter M
authors: PM
authors: Okin
authors: From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
authors: Evan L
authors: EL
authors: Thacker
authors: From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
authors: Kristen K
authors: KK
authors: Patton
authors: From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
authors: Phyllis K
authors: PK
authors: Stein
authors: From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
authors: Rebecca F
authors: RF
authors: Gottesman
authors: From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
authors: Susan R
authors: SR
authors: Heckbert
authors: From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
authors: Richard A
authors: RA
authors: Kronmal
authors: From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
authors: Mitchell S V
authors: MS
authors: Elkind
authors: From the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
authors: Elsayed Z
authors: EZ
authors: Soliman
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation; D001921:Brain / Q000503:physiopathology; D020520:Brain Infarction; D002318:Cardiovascular Diseases / Q000503:physiopathology; D020214:Cerebrovascular Trauma / Q000150:complications / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: arrhythmias, cardiac; electrocardiography; embolism; heart atrium; stroke