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(Stroke. 2005;36:2481.)
© 2005 American Heart Association, Inc.

Research Reports

Electrocardiographic Left Atrial Abnormalities and Risk of Ischemic Stroke

Shun Kohsaka, MD; Robert R. Sciacca, EngScD; Kenichi Sugioka, MD; Ralph L. Sacco, MD; Shunichi Homma, MD, FACC Marco R. Di Tullio, MD

From the Departments of Medicine (R.R.S., K.S., S.H., M.R.DiT.) and Neurology (R.L.S.), Columbia-Presbyterian Medical Center, New York, NY; and the Department of Cardiology (S.K.), Texas Heart Institute and Baylor College of Medicine, Houston.

Correspondence to Marco R. Di Tullio, MD, Professor of Clinical Medicine, Associate Director, Adult Echocardiography Laboratory, Columbia University Medical Center, PH3-342, 622 W 168th St, New York, NY 10032. E-mail md42{at}columbia.edu

Background and Purpose— We evaluated the association between electrocardiographic left atrial abnormality (ECG-LAA) and ischemic stroke, especially whether ECG-LAA provides additional prognostic information to that provided by echocardiography.

Methods— A population-based, case-control study included 146 patients with first ischemic stroke and 195 age-, gender-, and race/ethnicity-matched community control subjects. ECG-LAA was defined as either P-wave duration >120 ms or P-terminal force in precordial lead V₁ (PTFV₁) >40 ms·mm.

Results— PTFV₁ >40 ms·mm was associated with ischemic stroke after adjustment for other stroke risk factors (odds ratio [OR], 2.32; 95% CI, 1.29 to 4.18). The association remained significant after adding echocardiographic left atrial diameter to the model (OR, 2.31; 95% CI, 1.28 to 4.17). PTFV₁ was independently associated with stroke in patients in the upper half of echocardiographically determined left ventricular mass (adjusted OR, 4.5; 95% CI, 2.20 to 9.15) but not in those in the lower half (OR, 0.58; 95% CI, 0.20 to 1.65; P=0.0008).

Conclusions— ECG-LAA can supplement 2D echocardiography in assessing the risk of ischemic stroke, especially in subjects with increased left ventricular mass.

Key Words: echocardiography • electrocardiography • risk factors • stroke