P‐Wave Indices and the Risks of Incident Atrial Fibrillation and Ischemic Stroke in Black Adults: The Jackson Heart Study

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Abstract
Background: Atrial cardiomyopathy, defined as adverse changes to the cardiac atria, is an emerging risk factor for atrial fibrillation (AF). Despite the disproportionate burden of AF‐related complications in Black adults, the relationship between electrocardiographic (ECG) measures of atrial cardiomyopathy, referred to as P‐wave indices (PWIs), and outcomes remains largely unknown in this population. Methods: In 4900 participants without AF at baseline from the JHS (Jackson Heart Study), a prospective cohort study of Black adults, we assessed atrial cardiomyopathy using PWIs from resting 12‐lead ECGs: PR interval, P‐wave duration, P‐wave axis, and P‐wave terminal force in V1 (PTFV1). Cox proportional hazards models evaluated associations of PWIs with incident AF and ischemic stroke, adjusting for established risk factors. Results: Over 13.7 years of follow‐up, 396 (9.3%) participants developed incident AF, and 135 (3.8%) experienced ischemic stroke. Each SD‐unit increase in PR interval, P‐wave duration, and PTFV1 was associated with increased AF risk, with the strongest association for PTFV1 (hazard ratio [HR], 1.27 [95% CI, 1.16–1.38]). These PWIs were also associated with AF risk using clinically accepted thresholds, including HR of 1.76 for PTFV1 ≥4000 ms×μV (95%CI, 1.38–2.25). Each SD increase in PTFV1 was associated with a 22% increased risk of ischemic stroke (HR, 1.22 [95% CI, 1.07–1.40]). Conclusions: In this large cohort study of Black adults, PWIs, particularly PTFV1, were independently associated with an increased risk of incident AF and ischemic stroke. These findings underscore the significance of PTFV1 as an underlying marker of atrial cardiomyopathy in Black adults.

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