Background. Clinical risk factors identify subjects at risk of atrial fibrillation (AF) and ischemic stroke with only mediocre accuracy. Amplified P-wave duration (PWD) is a novel electrocardiographic marker for conduction delay in atrial cardiomyopathy, which in turn is associated with AF and cardioembolic stroke.
Objectives. The aim of this study is to assess whether amplified PWD can predict incident AF and ischemic stroke.
Methods. Amplified PWD was assessed manually on a signal-modified electrocardiogram in 2,054 participants from the population-based Hamburg City Health Study. Incident AF and ischemic stroke at 5-year follow-up were combined to a composite endpoint. The predictive power of amplified PWD alongside conventional clinical risk factors for the composite endpoint was evaluated.
Results. Over a median follow-up of 5.5 years, 126 participants developed AF (n=90) or ischemic stroke (n=36). In a Cox regression adjusted for age, sex, and body mass index, amplified PWD emerged as a predictor of the composite endpoint (Hazard Ratio [HR] per standard deviation [SD]: 1.37; p<.001) which was driven by incident AF (HR per SD: 1.46; p<.001), but not ischemic stroke (HR per SD: 1.04,; p=.751). Amplified PWD also proved to be of additional predictive value to the CHA2DS2-VA score (χ2=7.41; p=.006) and was superior to advanced interatrial block and P-wave terminal force in V1 (HR: 1.22; p=.029).
Conclusions. Amplified PWD as novel ECG-based marker predicts incident AF but not ischemic stroke in a population-based cohort and might carry additional prognostic value beyond conventional risk stratification.
