Department of Internal Medicine, Section on Hospital Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin.
Department of Internal Medicine, Section on Hospital Medicine and Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Am J Cardiol. 2022 Oct 1;180:59-64. doi: 10.1016/j.amjcard.2022.06.051. Epub 2022 Aug 6.
The link between abnormal P-wave axis (aPWA) and incident ischemic stroke is well established. However, studies examining the association between aPWA and fatal stroke are rare. We hypothesized that aPWA is associated with fatal stroke. We examined the association of abnormal aPWA with stroke mortality in 7,359 participants (60.0 ± 13.4 years, 51.9% women, 49.8% White) without cardiovascular (CV) disease (CVD) from the Third National Health and Nutrition Examination Survey. aPWA was defined as any value <0 or >75. The National Death Index was used to identify the date and cause of death. Cox proportional hazard analysis was used to examine the association between baseline aPWA with stroke mortality. Over a median follow-up of 14 years, 189 stroke deaths occurred. During follow-up, stroke mortality was more common in those with aPWA than those without aPWA (3.5% vs 2.2%, respectively; p = 0.002). In a multivariable-adjusted model, aPWA was associated with a 44% increased risk of stroke mortality (hazard ratio [HR] 95% confidence interval [CI] 1.44 [1.05 to 1.99]). This association was stronger in men than in women (HR 95% CI 2.29 [1.42 to 3.67] vs 1.00 [0.64 to 1.55]), respectively; p-interaction = 0.04) and among non-Whites than Whites (HR 95% CI 2.20 [1.39 to 3.46] vs. 1.07 [0.68 to 1.69], respectively; p-interaction = 0.09). The annualized stroke death rates/1,000 participants across levels of CHA2DS2-VASc scores were higher in those with than without aPWA. In conclusion, aPWA, a marker of atrial cardiopathy, is associated with an increased risk of stroke mortality, especially among men and non-Whites. Whether intensive risk factor modifications in those with aPWA would reduce the risk of stroke and thus, stroke mortality needs further investigation.
异常 P 波电轴（aPWA）与缺血性卒中事件之间的关联已得到充分证实。然而，研究异常 P 波电轴与致死性卒中之间的关联的研究却很少。我们假设 aPWA 与致死性卒中相关。我们在无心血管疾病（CVD）的 7359 名参与者（60.0±13.4 岁，51.9%为女性，49.8%为白人）中研究了异常 aPWA 与卒中死亡率之间的关联。aPWA 的定义为任何小于 0 或大于 75 的值。国家死亡索引用于确定死亡日期和原因。Cox 比例风险分析用于检查基线 aPWA 与卒中死亡率之间的关系。在中位数为 14 年的随访期间，发生了 189 例卒中死亡。在随访期间，aPWA 组的卒中死亡率高于无 aPWA 组（分别为 3.5%和 2.2%；p=0.002）。在多变量调整模型中，aPWA 与卒中死亡率增加 44%相关（风险比[HR]95%置信区间[CI]1.44[1.05 至 1.99]）。这种关联在男性中比女性中更强（HR 95%CI 2.29[1.42 至 3.67]与 1.00[0.64 至 1.55]，分别；p 交互作用=0.04），在非白种人比白人中更强（HR 95%CI 2.20[1.39 至 3.46]与 1.07[0.68 至 1.69]，分别；p 交互作用=0.09）。在 CHA2DS2-VASc 评分水平的每 1000 名参与者中，aPWA 患者的年化卒中死亡率更高。总之，aPWA，一种心房心肌病的标志物，与卒中死亡率增加相关，尤其是在男性和非白种人中。是否在 aPWA 患者中进行强化危险因素修正可以降低卒中风险，从而降低卒中死亡率，这需要进一步研究。
