Refining Prediction of Atrial Fibrillation Risk in the General Population With Analysis of P-Wave Axis (from the Atherosclerosis Risk in Communities Study)

Ankit Maheshwari, Faye L. Norby, Elsayed Z. Soliman, Ryan Koene, Mary Rooney, Wesley T. O'Neal, Alvaro Alonso, Lin Y. Chen

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Adverse atrial remodeling is associated with increased risk of atrial fibrillation (AF) and can be detected by a shift in P-wave axis. We aimed to determine whether an analysis of P-wave axis can be used to improve risk prediction of AF. We included 15,102 Atherosclerosis Risk in Communities Study participants who were free of AF at baseline. Abnormal P-wave axis (aPWA) was defined as any value outside 0 to 75 degrees on study visit 12-lead electrocardiograms. AF was determined using study visit electrocardiograms, death certificates, and hospital discharge records. Multivariable Cox regression was used to estimate hazard ratios and 95% confidence intervals (CIs) for the association of aPWA with AF. The Cohorts for Heart and Aging Research in Genomic Epidemiology-AF (CHARGE-AF) risk prediction model variables served as our benchmark. Improvement in 10-year AF prediction was assessed by C-statistic, category-based net reclassification improvement, and relative integrated discrimination improvement. During a mean follow-up of 20.2 years, there were 2,618 incident AF cases. aPWA was independently associated with a 2.34-fold (95% CI 2.12 to 2.58) increased risk of AF after adjusting for CHARGE-AF risk score variables. The use of aPWA improved the C-statistic from 0.719 (95% CI 0.702 to 0.736) to 0.722 (95% CI 0.705 to 0.739), which corresponded with a net reclassification improvement of 0.021 (95% CI 0.001, 0.040) and relative integrated discrimination improvement of 0.043 (95% CI 0.018, 0.069). In conclusion, aPWA is independently associated with AF in the general population. The use of this maker modestly improves AF prediction.

Original languageEnglish (US)
Pages (from-to)1980-1984
Number of pages5
JournalAmerican Journal of Cardiology
Issue number11
StatePublished - Dec 1 2017

Bibliographical note

Funding Information:
The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by the National Heart, Lung, and Blood Institute (Bethesda, Maryland) contracts HHSN268201100005C , HHSN268201100006C , HHSN268201100007C , HHSN268201100008C , HHSN268201100009C , HHSN268201100010C , HHSN268201100011C , and HHSN268201100012C . The authors thank the staff and participants of the Atherosclerosis Risk in Communities study for their important contributions.

Publisher Copyright:
© 2017 Elsevier Inc.


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