P-wave duration and interatrial block as predictors of ischemic stroke: A systematic review and meta-analysis

Sotirios Nedios (Leipzig)1, V. Lioutas (Boston)2, E. Koutalas (Leipzig)1, K. Zagoridis (Leipzig)1, S. Intzes (Leipzig)1, M. Symeonidou (Leipzig)1, P. Dilk (Leipzig)1, K. Bode (Leipzig)1, A. Bollmann (Leipzig)1

1Herzzentrum Leipzig - Universität Leipzig Rhythmologie Leipzig, Deutschland; 2Beth Israel Deaconess Medical Center Department of Neurology Boston, USA


Background: Ischemic stroke-risk has been associated with clinical characteristics, atrial remodeling and P-wave changes, like P-wave duration (PWD) or interatrial block (IAB). Despite the increasing evidence though, their use in risk-stratification remains limited. The aim of this review and meta-analysis was to examine the predictive value of PWD/IAB for stroke and offer practical implications.

Methods: Publication databases were systematically searched and studies reporting PWD and/or morphology at baseline and thromboembolic events (TEs) during follow-up (FUP) were included. IAB was defined as partial (pIAB) if PWD≥120 ms or advanced (aIAB) if the P-wave was biphasic in the inferior leads. After quality assessment and data extraction, random-effects analysis calculated odds ratio (OR) and confidence intervals (CI). Subgroup-analysis was performed to address heterogeneity.

Results: Among 180.997 patients (17 studies, mean 66 years old), including primary care patients (n=152.759), 15.578 (9%) had a new TE during 4 years of FUP. The pIAB was significant TE-risk predictor for non-primary care patients (OR:1.7; 95% CI:1.4-2.1) and those with prior TE (OR:1.8; 95% CI:1.4-2.2), but not for primary-care (OR:1.0) or those without prior TE (OR:1.3). The aIAB was significant TE-risk predictor both for primary (OR:1.6; 95% CI:1.4-1.9) and nonprimary care (OR:2.5; 95% CI:1.8-3.4) as well as those without (OR:2.2; 95% CI:1.1-4.4) or with prior TE (OR:2.6; 95% CI:1.4-4.7). There was heterogeneity but no publication bias in the subgroup-analysis.

Conclusion: Interatrial block is an independent predictor of TE-risk. The association is stronger for non-primary care patients or those with prior TE. Thus, PWD and IAB could be used as selection criteria for intensive screening, follow-up or interventions.


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