P-Wave Indices and Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis.

Abstract

Atrial cardiomyopathy is associated with an increased risk of ischemic stroke. P-wave terminal force in lead V₁, P-wave duration, and maximum P-wave area are electrocardiographic parameters that have been used to assess left atrial abnormalities related to developing atrial fibrillation. The aim of this systematic review and meta-analysis was to examine their values for predicting ischemic stroke risk. PubMed and EMBASE databases were searched until December 2016 for studies that evaluated the association between P-wave indices and stroke risk. Both fixed- and random-effects models were used to calculate the overall effect estimates. Ten studies examining P-wave terminal force in lead V₁, P-wave duration, and maximum P-wave area were included. P-wave terminal force in lead V₁ was found to be an independent predictor of stroke as both a continuous variable (odds ratio [OR] per 1 SD change, 1.18; 95% confidence interval [CI], 1.12-1.25; <i>P</i><0.0001) and categorical variable (OR, 1.59; 95% CI, 1.10-2.28; <i>P</i>=0.01). P-wave duration was a significant predictor of incident ischemic stroke when analyzed as a categorical variable (OR, 1.86; 95% CI, 1.37-2.52; <i>P</i><0.0001) but not when analyzed as a continuous variable (OR, 1.05; 95% CI, 0.98-1.13; <i>P</i>=0.15). Maximum P-wave area also predicted the risk of incident ischemic stroke (OR per 1 SD change, 1.10; 95% CI, 1.04-1.17). P-wave terminal force in lead V₁, P-wave duration, and maximum P-wave area are useful electrocardiographic markers that can be used to stratify the risk of incident ischemic stroke.