Electrocardiographic left atrial abnormality in patients presenting with ischemic stroke

Younghoon Kwon, Stephen McHugh, Kayvon Ghoreshi, Genevieve R. Lyons, Yeilim Cho, Kenneth C. Bilchick, Sula Mazimba, Bradford B. Worrall, Nazem Akoum, Lin Y. Chen, Elsayed Z. Soliman

Research output: Contribution to journalArticlepeer-review


Background: P wave indices represent electrocardiographic marker of left atrial pathology. We hypothesized that P wave would be more abnormal in patients presenting with ischemic stroke than a comparable group without ischemic stroke. Methods: We compared P wave terminal force in V1 (PTFV1) between patients admitted with ischemic stroke (case) and patients followed in cardiology clinic (control) at a single medical center. Using logistic regression models, we tested for an association between abnormal PTFV1 (> 4000 µV ms) and ischemic stroke. We also defined several optimal cut-off values of PTFV1 using a LOESS plot and estimated odds ratio of ischemic stroke when moving from one cut-point level to the next higher-level. Results: A total of 297 patients (case 147, control 150) were included. PTFV1 was higher in patients with vs. those without ischemic stroke (median 4620 vs 3994 µV ms; p=0.006). PTFV1 was similar between cardioembolic/cryptogenic and other stroke subtypes. In multivariable analyses adjusting for sex, obesity, age, and hypertension, the association between abnormal PTFV1 and ischemic stroke ceased to be significant (OR 1.53 [0.95, 2.50], p=0.083). Increase to the next cutoff level of PTFV1 (900, 2000, 3000, 4000, 5000, and 6000 µV ms) was associated with 18% increase in odds of having ischemic stroke (vs. no ischemic stroke) (OR 1.18 [1.02, 1.36], p=0.026). Conclusion: Patients presenting with acute ischemic stroke are more likely to have abnormal PTFV1. These findings from a real-world clinical setting support the results of cohort studies that left atrial pathology manifested as abnormal PTFV1 is associated with ischemic stroke.

Original languageEnglish (US)
Article number105086
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number9
StatePublished - Sep 2020

Bibliographical note

Funding Information:
This work was partly supported by the George Beller Award (University of Virginia Heart Vascular Institute) and NIH R21HL140432 (YK).

Publisher Copyright:
© 2020 Elsevier Inc.


  • Cardioembolic
  • Electrocardiography
  • Ischemic
  • P wave terminal force
  • Stroke


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