5 years ago

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

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 analysis of P-wave axis can be used to improve risk prediction of AF. We used data from the Atherosclerosis Risk In Communities study, a community-based prospective cohort study. We included 15,102 participants (age 54.2 ± 5.7 years, 55.2% women, 26.5% blacks) who attended the baseline exam (1987-89) and without AF. Abnormal P-wave axis (aPWA) was defined as any value outside 0-75 degrees on study visit 12-lead electrocardiograms (ECGs). AF was determined using study visit ECGs, death certificates, and hospital discharge records. Multivariable Cox regression was used to estimate hazard ratios and 95% confidence intervals (95% CIs) for the association of aPWA with AF. The Cohorts for Heart and Aging Research in Genomic Epidemiology (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 (NRI), and relative integrated discrimination improvement (IDI). During a mean follow-up of 20.2 years, there were 2618 incident AF cases. aPWA was independently associated with a 2.34-fold (95% CI, 2.12-2.58) increased risk of AF after adjusting for CHARGE-AF risk score variables. Use of aPWA improved the C-statistic from 0.719 (95% CI, 0.702-0.736) to 0.722 (95% CI, 0.705-0.739), which corresponded to NRI of 0.021 (95% CI, 0.001, 0.040) and IDI of 0.043 (95% CI, 0.018, 0.069). In conclusion, aPWA is independently associated with incident AF in the general population. Use of this maker modestly improves AF prediction.

Publisher URL: www.sciencedirect.com/science

DOI: S0002914917313851

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