Electrocardiographic atrial cardiomyopathy markers in sinus rhythm and the risk of incident atrial fibrillation and ischemic stroke a retrospective cohort study

IF 1.5 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology Pub Date : 2026-03-01 Epub Date: 2026-02-13 DOI:10.1016/j.jelectrocard.2026.154208

Sefa Erdi Ömür MD, Çağrı Zorlu MD, Gülşen Genç Tapar MD, Kayıhan Karaman MD, Metin Karayakali MD, Ataç Çelik MD

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引用次数: 0

Abstract

Background

Electrocardiographic (ECG) markers of atrial cardiomyopathy obtained in sinus rhythm may help identify outpatients at increased risk of incident atrial fibrillation (AF) and related adverse outcomes.

Aim

To evaluate the associations of P-wave terminal force in lead V1 (PTFV1) and deep terminal negativity of the P wave in V1 (DTNPV1) with incident AF and clinical outcomes in a contemporary outpatient cohort.

Methods

We conducted a retrospective cohort study of consecutive adults undergoing clinically indicated outpatient 12‑lead ECG in sinus rhythm between September 2022 and September 2025. Abnormal PTFV1 was defined as ≥4000 μV·ms and DTNPV1 as a biphasic P wave in V1 with terminal negative amplitude >100 μV. The primary endpoint was incident AF, defined as the first new AF episode after the index ECG requiring objective rhythm documentation on a 12‑lead ECG/rhythm strip or ambulatory monitor report (≥30 s); diagnostic codes alone were not sufficient. Secondary endpoints were incident ischemic stroke/TIA, heart failure (HF) hospitalization, all-cause mortality, and a composite outcome. Associations were assessed using Cox proportional hazards models with prespecified multivariable adjustment.

Results

The final cohort included 1500 patients; 400 (26.7%) had abnormal PTFV1. Over a median follow-up of 3.2 years, incident AF occurred in 301 patients (20.1%). AF incidence was higher in the abnormal vs normal PTFV1 groups (31.0% vs 16.1%), and abnormal PTFV1 independently predicted incident AF (adjusted HR 1.35, 95% CI 1.03–1.77). Abnormal PTFV1 was also associated with incident stroke/TIA (7.8% vs 4.0%; adjusted HR 1.34, 95% CI 1.01–1.78), incident HF hospitalization (17.5% vs 10.0%; adjusted HR 1.22, 95% CI 1.01–1.48), and the composite endpoint (37.5% vs 30.0%; adjusted HR 1.28, 95% CI 1.10–1.48). All-cause mortality was numerically higher but not statistically significant after adjustment (6.3% vs 4.5%; adjusted HR 1.35, 95% CI 0.82–2.21). DTNPV1 was not independently associated with incident AF after adjustment.

Conclusion

In outpatients with sinus-rhythm ECGs, abnormal PTFV1 is independently associated with higher risk of incident AF and other clinically relevant outcomes, supporting its potential role in targeted rhythm surveillance and risk stratification.

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窦性心律心电图心房心肌病标志物与心房颤动和缺血性脑卒中发生风险的回顾性队列研究。

背景：在窦性心律中获得心房心肌病的心电图（ECG）标记物可能有助于识别发生心房颤动（AF）和相关不良结局风险增加的门诊患者。目的：评估当代门诊队列中V1导联P波末端力（PTFV1）和V1 P波深端负性（DTNPV1）与AF事件和临床结局的关系。方法：我们对2022年9月至2025年9月期间连续接受临床指示门诊12导联心电图检查窦性心律的成年人进行了回顾性队列研究。PTFV1异常定义为≥4000 μV·ms， DTNPV1异常定义为V1双相P波，终末负振幅>100 μV。主要终点是偶发性房颤，定义为在指标ECG后首次出现新的房颤发作，需要在12导联心电图/节律条或动态监测报告上进行客观的心律记录（≥30 s）；仅诊断代码是不够的。次要终点是缺血性卒中/TIA事件、心力衰竭住院、全因死亡率和综合终点。使用预先指定的多变量调整的Cox比例风险模型评估相关性。结果：最终队列包括1500例患者；PTFV1异常400例（26.7%）。在中位随访3.2年期间，301例（20.1%）患者发生房颤。PTFV1异常组与正常组AF发生率较高（31.0% vs 16.1%）， PTFV1异常独立预测AF的发生（调整后HR 1.35, 95% CI 1.03-1.77）。PTFV1异常还与卒中/TIA事件（7.8% vs 4.0%；调整后危险度1.34,95% CI 1.01-1.78）、HF住院事件（17.5% vs 10.0%；调整后危险度1.22,95% CI 1.01-1.48）和综合终点（37.5% vs 30.0%；调整后危险度1.28,95% CI 1.10-1.48）相关。调整后的全因死亡率在数字上较高，但无统计学意义（6.3% vs 4.5%；调整后HR 1.35, 95% CI 0.82-2.21）。调整后DTNPV1与AF事件无独立相关性。结论：在有窦性心律心电图的门诊患者中，PTFV1异常与房颤发生风险升高和其他临床相关结局独立相关，支持其在靶向心律监测和风险分层中的潜在作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of electrocardiology 医学-心血管系统

CiteScore

2.70

自引率

7.70%

发文量

152

审稿时长

38 days

期刊介绍： The Journal of Electrocardiology is devoted exclusively to clinical and experimental studies of the electrical activities of the heart. It seeks to contribute significantly to the accuracy of diagnosis and prognosis and the effective treatment, prevention, or delay of heart disease. Editorial contents include electrocardiography, vectorcardiography, arrhythmias, membrane action potential, cardiac pacing, monitoring defibrillation, instrumentation, drug effects, and computer applications.