Abnormal P-Wave Axis and Ischemic Stroke: The ARIC Study (Atherosclerosis Risk in Communities): The ARIC Study (Atherosclerosis Risk in Communities)

A. Maheshwari, F.L. Norby, E.Z. Soliman, R.J. Koene, M.R. Rooney, W.T. O'Neal, A. Alonso, L.Y. Chen

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background and Purpose-Abnormal 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. Methods-We 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. Results-During 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. Conclusions- A PWA 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.

Original languageEnglish (US)
Pages (from-to)2060-2065
Number of pages6
Issue number8
StatePublished - 2017

Bibliographical note

Funding Information:
The ARIC study (Atherosclerosis Risk in Communities) is performed as a collaborative study supported by the National Heart, Lung, and Blood Institute contracts (HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN26820 1100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). Dr O'Neal is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number F32HL134290. Dr Chen is supported by R01HL126637. Additional support was provided by grant 16EIA26410001.

Publisher Copyright:
© 2017 American Heart Association, Inc.

Copyright 2017 Elsevier B.V., All rights reserved.


  • arrhythmias, cardiac
  • atrial fibrillation
  • electrophysiology
  • stroke


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