Key result
Abnormal P-wave terminal force in lead V1 was independently associated with an increased risk of incident dementia (HR 1.60; 95% CI 1.41-2.83) over a mean follow-up of 18 years.
Why the study?
Abnormal P-wave indices are associated with stroke independent of atrial fibrillation, but whether they are associated with incident dementia and cognitive decline was unknown.
Are abnormal P-wave indices associated with incident dementia and cognitive decline independent of atrial fibrillation and ischemic stroke?
Cohort (n=13,714)
Are abnormal P-wave indices associated with incident dementia and cognitive decline independent of atrial fibrillation and ischemic stroke?
Abnormal P-wave indices on ECG are independently associated with an increased risk of incident dementia over long-term follow-up.
Answers are grounded in this paper and cite their sources.
Abnormal P-wave indices may flag higher dementia risk on routine ECG; extends prior associations but leaves open predictive value beyond AF.
Background Abnormal P‐wave indices (PWIs)—reflecting underlying left atrial abnormality—are associated with increased risk of stroke independent of atrial fibrillation. We assessed whether abnormal PWIs are associated with incident dementia and greater cognitive decline, independent of atrial fibrillation and ischemic stroke. Methods and Results We included 13 714 participants (mean age, 57±6 years; 56% women; 23% black) who were followed for dementia through the end of 2015. (Abnormal P‐wave terminal force in lead V1, ≥4000 μV×ms), abnormal P‐wave axis (>75° or <0°), prolonged P‐wave duration (>120 ms), and advanced interatrial block were determined from ECGs at visits 2 to 4. Dementia was adjudicated by an expert panel using data from cognitive tests and hospitalization International Classification of Diseases codes. Cognitive function was measured longitudinally using 3 neuropsychological tests. Cox proportional hazards models were used to assess the association between time‐dependent abnormal PWIs with incident dementia. Linear regression models were used to evaluate PWIs with cognitive function over time. At the conclusion of the study, 19%, 16%, 28%, and 1.9% of participants had abnormal P‐wave terminal force in lead V1, abnormal P‐wave axis, prolonged P‐wave duration, and advanced interatrial block, respectively. During mean follow‐up of 18 years, there were 1390 (10%) dementia cases. All abnormal PWIs except advanced interatrial block were associated with an increased risk of dementia even after adjustment for incident atrial fibrillation and stroke: multivariable hazard ratio of abnormal P wave terminal force in lead V1=1.60, 95% CI, 1.41 to 2.83; abnormal P‐wave axis, hazard ratio =1.36, 95% CI, 1.17 to 2.57; prolonged P‐wave duration, hazard ratio=1.60, 95% CI, 1.42 to 1.80. Only abnormal P‐wave terminal force in lead V1 was associated with greater decline in global cognition. Conclusions Abnormal PWIs are independently associated with an increased risk of dementia. This novel finding should be replicated in other cohorts and the underlying mechanisms should be evaluated.
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Gutiérrez et al. (2019) conducted a cohort in Dementia and Cognitive Decline (n=13,714). Abnormal P-wave indices was evaluated on Incident dementia (HR 1.60, 95% CI 1.41-2.83). Abnormal P-wave terminal force in lead V1 was independently associated with an increased risk of incident dementia (HR 1.60; 95% CI 1.41-2.83) over a mean follow-up of 18 years.
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