P-wave indices and atrial fibrillation: Cross-cohort assessments from the Framingham Heart Study (FHS) and Atherosclerosis Risk in Communities (ARIC) study

Jared W. Magnani, Lei Zhu, Faye Lopez, Michael J. Pencina, Sunil K. Agarwal, Elsayed Z. Soliman, Emelia J. Benjamin, Alvaro Alonso

Research output: Contribution to journalArticlepeer-review

45 Scopus citations

Abstract

Background Atrial fibrillation (AF) is associated with increased morbidity. P-wave indices (PWIs) measure atrial electrical function and are associated with AF. Study of PWI has been limited to single-cohort investigations, and their contributions to risk enhancement are unknown. Methods We examined PWI from the FHS and ARIC study. We calculated 10-year AF risk using adjusted Cox models. We conducted cross-cohort meta-analyses for the PWI estimates and assessed their contributions to risk discrimination (c statistic), net reclassification index, and integrated discrimination improvement. Results After exclusions, the analysis included 3,110 FHS (62.6 ± 9.8 years, 56.9% women) and 8,254 ARIC participants (62.3 ± 5.6 years, 57.3% women, 20.3% black race). Over 10 years, 217 FHS and 458 ARIC participants developed AF. In meta-analysis, P-wave duration N120 milliseconds was significantly associated with AF (hazard ratio 1.55, 95% CI 1.29-1.85) compared with ≤120 milliseconds. P-wave area was marginally but not significantly related to AF (hazard ratio 1.31, 95% CI 0.95-1.80). P-wave terminal force was strongly associated with AF in ARIC but not FHS. P-wave indices had a limited contribution toward predictive risk beyond traditional risk factors and markers. Conclusions P-wave indices are intermediate phenotypes for AF. They are associated with AF in cross-cohort metaanalyses but contribute minimally toward enhancing risk prediction.

Original languageEnglish (US)
Pages (from-to)53-61.e1
JournalAmerican Heart Journal
Volume169
Issue number1
DOIs
StatePublished - Jan 2015

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