ArticleStroke2015
Association between left atrial abnormality on ECG and vascular brain injury on MRI in the Cardiovascular Health Study.
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Article in Stroke, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers.
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46citing papers in PubMed
5.7field-weighted citation impact, top 3% of its field
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Who cites it
46 citing papers in PubMed, 83 citations in OpenAlex.
- Effect of Intensive Blood Pressure Lowering on Incident Atrial Fibrillation and P-Wave Indices in the ACCORD Blood Pressure Trial.American journal of hypertension · 2016Trial
- Association of Atrial Electrophysiological Abnormalities With Cognitive Decline and Cerebrovascular Disease.Journal of the American Heart Association · 2026Article
- Association of P-Wave Parameters With Left Atrial Hemodynamics in Atrial Cardiomyopathy.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2026Article
- Visceral Embolic Events in Atrial Fibrillation: A Systematic Review and Meta-Analysis of Incidence, Mortality, and Risk Prediction.Journal of clinical medicine · 2025Review
- Associations of Midlife Leukocyte Telomere Length With Measures of Left Atrial Function in Community-Dwelling Older Adults: The ARIC Study.Journal of the American Heart Association · 2025Observational
- Electrocardiographic Indicators of Left Atrial Remodeling in Ischemic Stroke Patients with Atrial Fibrillation.Medical science monitor : international medical journal of experimental and clinical research · 2025Article
- Association of left atrial function with vascular brain injury: The Atherosclerosis Risk in Communities study.European journal of neurology · 2025Article
- Systemic determinants of brain health in ageing.Nature reviews. Neurology · 2024Review
- Association of abnormal p-wave parameters with brain MRI morphology: The atherosclerosis risk in communities neurocognitive study (ARIC-NCS).Pacing and clinical electrophysiology : PACE · 2023Article
- Association of Atrial Fibrillation With Stroke and Dementia Accounting for Left Atrial Function and Size.JACC. Advances · 2023Article
- Electrocardiogram properties and risk of covert brain infarction and other magnetic resonance imaging abnormalities in a stroke-free population.Brain and behavior · 2023Article
- High-Sensitivity C-Reactive Protein Modifies P-Wave Terminal Force in Lead V1-Associated Prognosis in Acute Ischemic Stroke or TIA Patients.Journal of clinical medicine · 2023Article
- Prognostic significance of atrial cardiopathy in patients with acute ischemic stroke.European stroke journal · 2023Article
- Relationship Between High Blood Pressure, Atrial Cardiopathy, and Mortality in the General Population.American journal of hypertension · 2023Article
- Deep terminal negativity of the P-wave in V1 and stroke risk: The National Health and Nutrition Examination survey III.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2022Article
- P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research-A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology.Circulation. Arrhythmia and electrophysiology · 2022Review
- Electrocardiographic diagnosis of atrial cardiomyopathy to predict atrial contractile dysfunction, thrombogenesis and adverse cardiovascular outcomes.Scientific reports · 2022Article
- Left Atrial Cardiomyopathy - A Challenging Diagnosis.Frontiers in cardiovascular medicine · 2022Review
- Left atrial dimension and ischemic stroke in patients with and without atrial fibrillation.Heart and vessels · 2021Article
- A Mendelian randomization analysis of the relationship between cardioembolic risk factors and ischemic stroke.Scientific reports · 2021Article
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Authors and funding
12 authors at 5 institutions in 1 country.
Hooman KamelFrom the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.). hok9010@med.cornell.edu.
Traci M BartzFrom the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
W T LongstrethFrom the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
Peter M OkinFrom the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
Evan L ThackerFrom the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
Kristen K PattonFrom the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
Phyllis K SteinFrom the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
Rebecca F GottesmanFrom the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
Susan R HeckbertFrom the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
Richard A KronmalFrom the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
Mitchell S V ElkindFrom the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
Elsayed Z SolimanFrom the Department of Neurology and Brain and Mind Research Institute (H.K.), Department of Medicine (P.M.O.), Weill Cornell Medical College, New York, NY (H.K.); Department of Biostatistics (T.M.B.), Departments of Neurology, Epidemiology, and Medicine (W.T.L.), Department of Medicine (K.K.P.), Cardiovascular Health Research Unit and Department of Epidemiology (S.R.H.), and Department of Biostatistics and Collaborative Health Studies Coordinating Center (R.A.K.), University of Washington, Seattle; Department of Health Science, Brigham Young University, Provo, UT (E.L.T.); Department of Medicine, Washington University School of Medicine, St. Louis, MO (P.K.S.); Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD (R.F.G.); Department of Neurology, College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E.); and Department of Epidemiology and Prevention, Epidemiological Cardiology Research Center, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.).
Washington University in St. Louis · USJohns Hopkins Medicine · USCornell University · USJohns Hopkins University · USMIND Research Institute · US
Funding
Exceptional Survival: Trajectories to Functional Aging (CHS All Stars)R01AG023629 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI NEWMAN, ANNE B. · 2004 to 2016
$9.5MCHS Events Follow-up StudyU01HL080295 · NHLBI · UNIVERSITY OF WASHINGTON · PI PSATY, BRUCE M · 2005 to 2008
$4.6MRole of EIIIA fibronectin in pulmonary fibrosisR01HL085083 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI WHITE, ERIC S · 2007 to 2011
$1.9MAtrial Fibrillation Precursors May Be Novel Stroke Risk FactorsK23NS082367 · NINDS · WEILL MEDICAL COLL OF CORNELL UNIV · PI KAMEL, HOOMAN · 2013 to 2017
$937kCORONARY HEART DISEASE &STROKE IN THE ELDERLYN01HC085080 · HC · WAKE FOREST UNIVERSITY · PI BURKE, GREGORY L · 1988 to 2000
–CORONARY HEART DISEASE &STROKE IN PEOPLE AGED 65-84N01HC085081 · HC · JOHNS HOPKINS UNIVERSITY · PI FRIED, LINDA P · 1988 to 2000
–CORONARY HEART DISEASE AND STROKE IN PEOPLE AGED 65-84N01HC085082 · HC · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI KULLER, LEWIS H · 1988 to 2000
–CORONARY HEART DISEASE &STROKE IN PEOPLE AGED 65-84N01HC085083 · HC · UNIVERSITY OF CALIFORNIA DAVIS · PI ROBBINS, JOHN A · 1988 to 1999
–CENTRAL BLOOD ANALYSIS LABORATORY FOR CHSN01HC085086 · HC · UNIVERSITY OF VERMONT &ST AGRIC COLLEGE · PI TRACY, RUSSELL P · 1988 to 2000
–CORONARY HEART DISEASE &STROKE IN PEOPLE AGED 65 TO 84N01HC085079 · HC · UNIVERSITY OF WASHINGTON · 1988 to 2005
–CHS-Transition Phase -268055222-268055222N01HC055222 · HC · UNIVERSITY OF WASHINGTON · PI KRONMAL, RICHARD A · 2005 to 2006
–MRI READING CENTER FOR THE CARDIOVASCULAR HEALTH STUDYN01HC015103 · HC · JOHNS HOPKINS UNIVERSITY · PI BEAUCHAMP, NORMAN J · 1991 to 1998
–NHLBI NIH HHS HHSN268200800007CNHLBI NIH HHS HHSN268201200036CNHLBI NIH HHS N01 HC015103NHLBI NIH HHS N01 HC055222NHLBI NIH HHS N01 HC085079NHLBI NIH HHS N01 HC085080NHLBI NIH HHS N01 HC085081NHLBI NIH HHS N01 HC085082NHLBI NIH HHS N01 HC085083NHLBI NIH HHS N01 HC085086NHLBI NIH HHS N01HC15103NHLBI NIH HHS U01 HL080295NHLBI NIH HHS U01HL080295NIA NIH HHS R01 AG023629NIA NIH HHS R01AG023629NINDS NIH HHS K23 NS082367NINDS NIH HHS K23NS082367
Abstract
background and purposeEmerging evidence suggests that atrial disease is associated with vascular brain injury in the absence of atrial fibrillation.
methodsThe Cardiovascular Health Study prospectively enrolled community-dwelling adults aged ≥65 years. Among participants who underwent MRI, we examined associations of ECG left atrial abnormality with brain infarcts and leukoaraiosis. P-wave terminal force in lead V1 was the primary measure of left atrial abnormality; P-wave area and duration were secondary predictors. We excluded participants with atrial fibrillation before or on their index ECG. Primary outcomes were incident infarcts and worsening leukoaraiosis from initial to follow-up scan ≈5 years later. Secondary outcomes were prevalent infarcts and degree of leukoaraiosis on initial MRI. Relative risk (RR) and linear regression models were adjusted for vascular risk factors.
resultsAmong 3129 participants with ≥1 scan, each SD increase in P-wave terminal force in lead V1 was associated with a 0.05-point (95% confidence interval [CI], 0.0003-0.10) higher baseline white matter grade on a 10-point scale. P-wave terminal force in lead V1 was associated with prevalent infarcts of any type (RR per SD, 1.09; 95% CI, 1.04-1.16) and more so with prevalent nonlacunar infarcts (RR per SD, 1.22; 95% CI, 1.08-1.38). Among 1839 participants with 2 scans, P-wave terminal force in lead V1 was associated with worsening leukoaraiosis (RR per SD, 1.09; 95% CI, 1.01-1.18), but not with incident infarcts (RR per SD, 1.06; 95% CI, 0.93-1.20). Sensitivity analyses adjusting for incident atrial fibrillation found similar results. P-wave area and duration were not associated with outcomes.
conclusionsECG left atrial abnormality is associated with vascular brain injury in the absence of documented atrial fibrillation.
Indexed as
ElectrocardiographyMagnetic Resonance ImagingAgedAtrial FibrillationBrainBrain InfarctionCardiovascular DiseasesCerebrovascular TraumaFemaleHeart AtriaHeart DiseasesHumansLinear ModelsMaleMiddle AgedPredictive Value of Testsarrhythmias, cardiacelectrocardiographyembolismheart atriumstroke
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