Association of abnormal p-wave parameters with brain MRI morphology: The atherosclerosis risk in communities neurocognitive study (ARIC-NCS)*

Jorge L. Reyes, Faye L. Norby, Yuekai Ji, Wendy Wang, Romil Parikh, Michael J. Zhang, Niki C. Oldenburg, Pamela L. Lutsey, Clifford R. Jack, Michelle Johansen, Rebecca F. Gottesman, Josef Coresh, Thomas Mosley, Elsayed Z. Soliman, Alvaro Alonso, Lin Yee Chen

Research output: Contribution to journalArticlepeer-review


Background: Recent evidence indicates that abnormal P-wave parameters (PWPs)—ECG markers of atrial myopathy—are associated with incident dementia, independent of atrial fibrillation (AF) and clinical ischemic stroke. However, the mechanisms remain unclear and may include subclinical vascular brain injury. Hence, we evaluated the association of abnormal PWPs with brain MRI correlates of vascular brain injury in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). Methods: ARIC-NCS participants who underwent 3T brain MRI scans in 2011–2013 were included. PWPs were measured from standard 12-lead ECGs. Brain MRI outcomes included cortical infarcts, lacunar infarcts, cerebral microhemorrhages, brain volumes, and white matter disease (WMD) volume. We used weighted multivariable logistic and linear regression to evaluate the associations of abnormal PWPs with brain MRI outcomes. Results: Among 1715 participants (mean age, 76.1 years; 61% women; 29% Black), 797 (46%) had ≥1 abnormal PWP. After multivariable adjustment, including adjusting for prevalent AF, abnormal P-wave terminal force in lead V1 (aPTFV1) and prolonged P-wave duration (PPWD) were associated with increased odds of both cortical (OR 1.41; 95% CI, 1.14 to 1.74 and OR 1.30; 95% CI, 1.04 to 1.63, respectively) and lacunar infarcts (OR 1.36; 95% CI, 1.15 to 1.63 and OR 1.37; 95% CI, 1.15 to 1.65, respectively). Advanced interatrial block (aIAB) was associated with higher odds of subcortical microhemorrhage (OR 2.04; 95% CI, 1.36 to 3.06). Other than a significant association between aPTFV1 with lower parietal lobe volume, there were no other significant associations with brain or WMD volume. Conclusion: In this exploratory analysis of a US community-based cohort, ECG surrogates of atrial myopathy are associated with a higher prevalence of brain infarcts and microhemorrhage, suggesting subclinical vascular brain injury as a possible mechanism underlying the association of atrial myopathy with dementia.

Original languageEnglish (US)
Pages (from-to)951-959
Number of pages9
JournalPACE - Pacing and Clinical Electrophysiology
Issue number8
StatePublished - Aug 2023

Bibliographical note

Funding Information:
The authors thank the staff and participants of the ARIC study for their important contributions. The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract numbers (HHSN268201700001l, HHSN268201700002l, HHSN2682017000003l, HHSN2682017000005l, and HHSB 2682017000004l). Dr Chen is supported by R01HL41288, R01 HL126637, RF1 NS127266, R01 HL158022, and K24HL155813. Dr. Alonso is supported by NHLBI grant K24HL148521.

Publisher Copyright:
© 2023 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.


  • P-waves parameters
  • brain infarcts
  • microhemorrhages

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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