TY - JOUR
T1 - P-wave indices and atrial fibrillation
T2 - Cross-cohort assessments from the Framingham Heart Study (FHS) and Atherosclerosis Risk in Communities (ARIC) study
AU - Magnani, Jared W.
AU - Zhu, Lei
AU - Lopez, Faye
AU - Pencina, Michael J.
AU - Agarwal, Sunil K.
AU - Soliman, Elsayed Z.
AU - Benjamin, Emelia J.
AU - Alonso, Alvaro
N1 - Publisher Copyright:
© 2014 Elsevier Inc. All rights reserved.
PY - 2015/1
Y1 - 2015/1
N2 - Background Atrial fibrillation (AF) is associated with increased morbidity. P-wave indices (PWIs) measure atrial electrical function and are associated with AF. Study of PWI has been limited to single-cohort investigations, and their contributions to risk enhancement are unknown. Methods We examined PWI from the FHS and ARIC study. We calculated 10-year AF risk using adjusted Cox models. We conducted cross-cohort meta-analyses for the PWI estimates and assessed their contributions to risk discrimination (c statistic), net reclassification index, and integrated discrimination improvement. Results After exclusions, the analysis included 3,110 FHS (62.6 ± 9.8 years, 56.9% women) and 8,254 ARIC participants (62.3 ± 5.6 years, 57.3% women, 20.3% black race). Over 10 years, 217 FHS and 458 ARIC participants developed AF. In meta-analysis, P-wave duration N120 milliseconds was significantly associated with AF (hazard ratio 1.55, 95% CI 1.29-1.85) compared with ≤120 milliseconds. P-wave area was marginally but not significantly related to AF (hazard ratio 1.31, 95% CI 0.95-1.80). P-wave terminal force was strongly associated with AF in ARIC but not FHS. P-wave indices had a limited contribution toward predictive risk beyond traditional risk factors and markers. Conclusions P-wave indices are intermediate phenotypes for AF. They are associated with AF in cross-cohort metaanalyses but contribute minimally toward enhancing risk prediction.
AB - Background Atrial fibrillation (AF) is associated with increased morbidity. P-wave indices (PWIs) measure atrial electrical function and are associated with AF. Study of PWI has been limited to single-cohort investigations, and their contributions to risk enhancement are unknown. Methods We examined PWI from the FHS and ARIC study. We calculated 10-year AF risk using adjusted Cox models. We conducted cross-cohort meta-analyses for the PWI estimates and assessed their contributions to risk discrimination (c statistic), net reclassification index, and integrated discrimination improvement. Results After exclusions, the analysis included 3,110 FHS (62.6 ± 9.8 years, 56.9% women) and 8,254 ARIC participants (62.3 ± 5.6 years, 57.3% women, 20.3% black race). Over 10 years, 217 FHS and 458 ARIC participants developed AF. In meta-analysis, P-wave duration N120 milliseconds was significantly associated with AF (hazard ratio 1.55, 95% CI 1.29-1.85) compared with ≤120 milliseconds. P-wave area was marginally but not significantly related to AF (hazard ratio 1.31, 95% CI 0.95-1.80). P-wave terminal force was strongly associated with AF in ARIC but not FHS. P-wave indices had a limited contribution toward predictive risk beyond traditional risk factors and markers. Conclusions P-wave indices are intermediate phenotypes for AF. They are associated with AF in cross-cohort metaanalyses but contribute minimally toward enhancing risk prediction.
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U2 - 10.1016/j.ahj.2014.10.009
DO - 10.1016/j.ahj.2014.10.009
M3 - Article
C2 - 25497248
AN - SCOPUS:84926174260
SN - 0002-8703
VL - 169
SP - 53-61.e1
JO - American Heart Journal
JF - American Heart Journal
IS - 1
ER -