title: Electrocardiographic Left Atrial Abnormality and Risk of Stroke: Northern Manhattan Study.
abstract: OBJECTIVE
  Electrocardiographic left atrial abnormality has been associated with stroke independently of atrial fibrillation (AF), suggesting that atrial thromboembolism may occur in the absence of AF. If true, we would expect an association with cryptogenic or cardioembolic stroke rather than noncardioembolic stroke.
  
  
  METHODS
  We conducted a case-cohort analysis in the Northern Manhattan Study, a prospective cohort study of stroke risk factors. P-wave terminal force in lead V1 was manually measured from baseline ECGs of participants in sinus rhythm who subsequently had ischemic stroke (n=241) and a randomly selected subcohort without stroke (n=798). Weighted Cox proportional hazard models were used to examine the association between P-wave terminal force in lead V1 and stroke etiologic subtypes while adjusting for baseline demographic characteristics, history of AF, heart failure, diabetes mellitus, hypertension, tobacco use, and lipid levels.
  
  
  RESULTS
  Mean P-wave terminal force in lead V1 was 4452 (±3368) μV*ms among stroke cases and 3934 (±2541) μV*ms in the subcohort. P-wave terminal force in lead V1 was associated with ischemic stroke (adjusted hazard ratio per SD, 1.20; 95% confidence interval, 1.03-1.39) and the composite of cryptogenic or cardioembolic stroke (adjusted hazard ratio per SD, 1.31; 95% confidence interval, 1.08-1.58). There was no definite association with noncardioembolic stroke subtypes (adjusted hazard ratio per SD, 1.14; 95% confidence interval, 0.92-1.40). Results were similar after excluding participants with a history of AF at baseline or new AF during follow-up.
  
  
  CONCLUSIONS
  ECG-defined left atrial abnormality was associated with incident cryptogenic or cardioembolic stroke independently of the presence of AF, suggesting atrial thromboembolism may occur without recognized AF.
authors.affiliation: From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.). hok9010@med.cornell.edu.
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.affiliation: From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.).
authors.forename: Madeleine
authors.initials: M
authors.lastname: Hunter
authors.affiliation: From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.).
authors.forename: Yeseon P
authors.initials: YP
authors.lastname: Moon
authors.affiliation: From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.).
authors.forename: Shadi
authors.initials: S
authors.lastname: Yaghi
authors.affiliation: From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.).
authors.forename: Ken
authors.initials: K
authors.lastname: Cheung
authors.affiliation: From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.).
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
authors.affiliation: From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.).
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
authors.affiliation: From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.).
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.).
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: From the Department of Neurology, Feil Family Brain and Mind Research Institute (H.K.) and Division of Cardiology (P.M.O.), Weill Cornell Medical College, New York; Department of Neurology (M.H., Y.P.M., S.Y., K.C., M.S.V.E.) and Division of Cardiology (M.R.D.T.), Columbia College of Physicians and Surgeons, New York; Department of Biostatistics, Columbia Mailman School of Public Health, New York (K.C.); Department of Neurology, Human Genetics, and Public Health Sciences, Miller School of Medicine, University of Miami, FL (R.L.S.); Departments of Epidemiology and Prevention (E.Z.S.) and Internal Medicine-Cardiology (E.Z.S.), Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC; and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York (M.S.V.E.).
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000503:physiopathology; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*
keywords: atrial fibrillation; cardiomyopathies; cohort studies; embolism; stroke