From the Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China (J.H., G.L., T.L.); Department of Medicine and Therapeutics (G.T.) and Li Ka Shing Institute of Health Science (G.T.), Chinese University of Hong Kong, SAR, People's Republic of China; First Department of Cardiology, University Hospital of Ioannina, Greece (P.K.); Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, "Evangelismos" General Hospital of Athens, Greece (K.P.L.); Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran (S.A.-H.-A.-S.); Weill Cornell Medical College, New York, NY (H.K.); Institute of Cardiovascular Sciences, University of Birmingham, United Kingdom (G.Y.H.L.); and Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Denmark (G.Y.H.L.).
Stroke. 2017 Aug;48(8):2066-2072. doi: 10.1161/STROKEAHA.117.017293. Epub 2017 Jul 5.
Atrial cardiomyopathy is associated with an increased risk of ischemic stroke. P-wave terminal force in lead V, P-wave duration, and maximum P-wave area are electrocardiographic parameters that have been used to assess left atrial abnormalities related to developing atrial fibrillation. The aim of this systematic review and meta-analysis was to examine their values for predicting ischemic stroke risk.
PubMed and EMBASE databases were searched until December 2016 for studies that evaluated the association between P-wave indices and stroke risk. Both fixed- and random-effects models were used to calculate the overall effect estimates.
Ten studies examining P-wave terminal force in lead V, P-wave duration, and maximum P-wave area were included. P-wave terminal force in lead V was found to be an independent predictor of stroke as both a continuous variable (odds ratio [OR] per 1 SD change, 1.18; 95% confidence interval [CI], 1.12-1.25; <0.0001) and categorical variable (OR, 1.59; 95% CI, 1.10-2.28; =0.01). P-wave duration was a significant predictor of incident ischemic stroke when analyzed as a categorical variable (OR, 1.86; 95% CI, 1.37-2.52; <0.0001) but not when analyzed as a continuous variable (OR, 1.05; 95% CI, 0.98-1.13; =0.15). Maximum P-wave area also predicted the risk of incident ischemic stroke (OR per 1 SD change, 1.10; 95% CI, 1.04-1.17).
P-wave terminal force in lead V, P-wave duration, and maximum P-wave area are useful electrocardiographic markers that can be used to stratify the risk of incident ischemic stroke.
心房心肌病与缺血性卒中风险增加相关。P 波终末电势在 V 导联、P 波时限和最大 P 波面积是心电图参数，可用于评估与房颤发生相关的左心房异常。本系统评价和荟萃分析的目的是检验它们预测缺血性卒中风险的价值。
检索 PubMed 和 EMBASE 数据库，直到 2016 年 12 月，以评估 P 波指数与卒中风险之间的关系。使用固定效应模型和随机效应模型计算总体效应估计值。
纳入 10 项研究，评估了 V 导联 P 波终末电势、P 波时限和最大 P 波面积与卒中的相关性。V 导联 P 波终末电势既是连续变量（每 1 SD 变化的比值比，1.18；95%置信区间，1.12-1.25；<0.0001）也是分类变量（比值比，1.59；95%置信区间，1.10-2.28；=0.01）的卒中独立预测因子。当作为分类变量进行分析时，P 波时限是缺血性卒中事件的显著预测因子（比值比，1.86；95%置信区间，1.37-2.52；<0.0001），但作为连续变量进行分析时并非如此（比值比，1.05；95%置信区间，0.98-1.13；=0.15）。最大 P 波面积也预测了缺血性卒中事件的风险（每 1 SD 变化的比值比，1.10；95%置信区间，1.04-1.17）。
V 导联 P 波终末电势、P 波时限和最大 P 波面积是有用的心电图标志物，可用于分层缺血性卒中事件的风险。
