ArticleStroke2017
Abnormal P-Wave Axis and Ischemic Stroke: The ARIC Study (Atherosclerosis Risk In Communities).
Article in Stroke, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
31 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Atrial cardiomyopathy and incident ischemic stroke risk: a systematic review and meta-analysis.Journal of neurology · 2023Pooled it
- Atrial Cardiomyopathy Detected by Electrocardiogram: Association with Stroke in a Brazilian Electronic Cohort.Arquivos brasileiros de cardiologia · 2026Article
- Metabolic Syndrome and Atrial Cardiomyopathy on the Risk of Stroke Mortality in the General Population.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 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
- Electrocardiogram markers predicting ischemic stroke after acute coronary syndrome.International journal of cardiology. Cardiovascular risk and prevention · 2025Article
- P-Wave Indices and the Risks of Incident Atrial Fibrillation and Ischemic Stroke in Black Adults: The Jackson Heart Study.Journal of the American Heart Association · 2025Article
- Electrocardiographic P-wave indices and onset of atrial fibrillation and histological fibrosis in a general Japanese population: a prospective cohort analysis of the Hisayama Study.European heart journal open · 2025Article
- Atrial Cardiomyopathy: From Diagnosis to Treatment.Reviews in cardiovascular medicine · 2025Review
- Artificial Intelligence-Enabled Electrocardiography Predicts Future Pacemaker Implantation and Adverse Cardiovascular Events.Journal of medical systems · 2024Article
- Recovery from Severe COVID-19 Is an Independent Predictor of Electrocardiographic Abnormal P-Wave Axis.Diagnostics (Basel, Switzerland) · 2024Article
- The relationship between atrial cardiopathy biomarkers and prognosis of patients with acute ischemic stroke after endovascular treatment.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2024Article
- Interatrial Block, Bayés Syndrome, Left Atrial Enlargement, and Atrial Failure.Journal of clinical medicine · 2023Review
- 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
- New electrocardiographic aspects of the P wave: Its value in clinical cardiology.Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc · 2023Review
- P-wave parameters and their association with thrombi and spontaneous echo contrast in the left atrial appendage.Clinical cardiology · 2023Article
- Left Atrial Mechanical Dysfunction and the Risk for Ischemic Stroke in People Without Prevalent Atrial Fibrillation or Stroke : A Prospective Cohort Study.Annals of internal medicine · 2023Article
- Left Atrial Remodeling and Stroke in Patients With Sinus Rhythm and Normal Ejection Fraction: ARIC-NCS.Journal of the American Heart Association · 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
- Secondhand smoke exposure is associated with abnormal P-wave axis.Public health · 2022Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
background and purposeAbnormal P-wave axis (aPWA) has been linked to incident atrial fibrillation and mortality; however, the relationship between aPWA and stroke has not been reported. We hypothesized that aPWA is associated with ischemic stroke independent of atrial fibrillation and other stroke risk factors and tested our hypothesis in the ARIC study (Atherosclerosis Risk In Communities), a community-based prospective cohort study.
methodsWe included 15 102 participants (aged 54.2±5.7 years; 55.2% women; 26.5% blacks) who attended the baseline examination (1987-1989) and without prevalent stroke. We defined aPWA as any value outside 0 to 75° using 12-lead ECGs obtained during study visits. Each case of incident ischemic stroke was classified in accordance with criteria from the National Survey of Stroke by a computer algorithm and adjudicated by physician review. Multivariable Cox regression was used to estimate hazard ratios and 95% confidence intervals for the association of aPWA with stroke.
resultsDuring a mean follow-up of 20.2 years, there were 657 incident ischemic stroke cases. aPWA was independently associated with a 1.50-fold (95% confidence interval, 1.22-1.85) increased risk of ischemic stroke in the multivariable model that included atrial fibrillation. When subtyped, aPWA was associated with a 2.04-fold (95% confidence interval, 1.42-2.95) increased risk of cardioembolic stroke and a 1.32-fold (95% confidence interval, 1.03-1.71) increased risk of thrombotic stroke.
conclusionsaPWA is independently associated with ischemic stroke. This association seems to be stronger for cardioembolic strokes. Collectively, our findings suggest that alterations in atrial electric activation may predispose to cardiac thromboembolism independent of atrial fibrillation.
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