Advanced interatrial block and ischemic stroke: The Atherosclerosis Risk in Communities Study.

Pubmed ID: 27343071

Pubmed Central ID: PMC4977113

Journal: Neurology

Publication Date: July 26, 2016

Affiliation: From the Department of Medicine (W.T.O.) and Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention (Z.-M.Z., E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC; Department of Neurology (H.K.), Weill Cornell Medical College, New York, NY; and Department of Medicine, Cardiovascular Division (L.Y.C.), and Division of Epidemiology and Community Health, School of Public Health (A.A.), University of Minnesota, Minneapolis, MN. W.T.O. is currently with the Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA; and A.A. is currently with the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.

MeSH Terms: Humans, Male, Female, Risk Factors, Middle Aged, Smoking, Prevalence, Atrial Fibrillation, Prospective Studies, Follow-Up Studies, Incidence, Stroke, Electrocardiography, Brain Ischemia, Atrial Function, Left, Atrioventricular Block, Black or African American

Grants: HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, HHSN268201100012C, HHSN268201100009I, HHSN268201100005G, HHSN268201100008I, HHSN268201100011I, HHSN268201100005I, HHSN268201100007I

Authors: O'Neal WT, Zhang ZM, Soliman EZ, Kamel H, Chen LY, Alonso A

Cite As: O'Neal WT, Kamel H, Zhang ZM, Chen LY, Alonso A, Soliman EZ. Advanced interatrial block and ischemic stroke: The Atherosclerosis Risk in Communities Study. Neurology 2016 Jul 26;87(4):352-6. Epub 2016 Jun 24.

Studies:

Abstract

OBJECTIVE: Given that recent reports have suggested left atrial disease to be an independent risk factor for ischemic stroke, we sought to examine if advanced interatrial block (aIAB) is an independent stroke risk factor. METHODS: We examined the association between aIAB and incident ischemic stroke in 14,716 participants (mean age 54 ± 5.8 years; 55% female; 26% black) from the Atherosclerosis Risk in Communities Study (ARIC). Cases of aIAB were identified from digital ECGs recorded during the baseline ARIC visit (1987-1989) and the first 3 follow-up study visits (1990-1992, 1993-1995, and 1996-1998). Adjudicated ischemic stroke events were ascertained through December 31, 2010. RESULTS: There were 266 (1.8%) participants who had evidence of aIAB. Over a median follow-up of 22 years, 916 (6.2%) ischemic stroke events were detected. The incidence rate (per 1,000 person-years) of ischemic stroke among those with aIAB (incidence rate 8.05, 95% confidence interval [CI] 5.7, 11.4) was more than twice the rate in those without aIAB (incidence rate 3.14, 95% CI 2.94, 3.35). In a multivariable Cox regression analysis adjusted for stroke risk factors and potential confounders, aIAB was associated with an increased risk of ischemic stroke (hazard ratio 1.63, 95% CI 1.13, 2.34). The results were consistent across subgroups of participants stratified by age, sex, and race. CONCLUSIONS: In the ARIC, aIAB was associated with incident ischemic stroke, which strengthens the hypothesis that left atrial disease should be considered an independent stroke risk factor.