Abnormal P-wave axis predicts major adverse cardiovascular events in patients with ischaemic stroke or transient ischaemic attack

Abstract

BACKGROUND: Abnormal P-wave axis (aPWA) on 12-lead electrocardiogram (ECG) can occur in the context of atrial conduction or structural abnormalities and has been thought to be a surrogate marker of atrial fibrosis and linked to atrial fibrillation (AF). This study sought to assess whether the presence of aPWA can prognosticate cardiovascular outcomes in patients admitted with ischaemic neurovascular events without captured AF. METHODS: This study recruited patients admitted with ischaemic stroke or transient ischaemic attack in sinus rhythm without a history of AF (2019-2021); these patients underwent ECG, echocardiographic and radiologic investigations, and were categorised into normal P-wave axis (nPWA; axis 0-75degree) and aPWA (axis <0degreeor >75degree). They were followed for 18 months for major adverse cardiovascular events (MACE: death, stroke, myocardial infarction, hospitalisation for heart failure, arrhythmia, or revascularisation). RESULTS: A total of 570 patients were included (70.6+/-14.6 years; 55.8% men), of whom 112 had aPWA and 458 had nPWA. There were no significant between-group differences in gender, CHA2DS2-VASC score, or prevalence of ischaemic heart disease, heart failure, prior stroke, hypertension, hyperlipidaemia, diabetes mellitus, obstructive sleep apnoea, obesity, and chronic kidney disease. The aPWA group was older (69.4 vs 75.6 years; <0.01). Log-rank test demonstrated that aPWA was associated with reduced freedom from MACE as a function of time (p<0.01; Figure 1). Cox-regression analysis confirmed that aPWA was associated with MACE independent of age (adjusted hazard ratio 2.0; p<0.01). CONCLUSIONS: The presence of aPWA in patients admitted with ischaemic stroke or transient ischaemic attack is associated with a higher risk of MACE. These patients may benefit from intensified follow-up and therapy.