Electrocardiographic deep terminal negativity of the P wave in V1 and risk of sudden cardiac death

The atherosclerosis risk in communities (aric) study

Larisa Tereshchenko, Charles Henrikson, Nona Sotoodehnia, Dan E. Arking, Sunil K. Agarwal, David S. Siscovick, Wendy S. Post, Scott D. Solomon, Josef Coresh, Mark E. Josephson, Elsayed Z. Soliman

    Research output: Contribution to journalArticle

    23 Citations (Scopus)

    Abstract

    Background: Identifying individuals at risk for sudden cardiac death (SCD) is of critical importance. Electrocardiographic (ECG) deep terminal negativity of P wave in V1 (DTNPV1), a marker of left atrial abnormality, has been associated with increased risk of allcause and cardiovascular mortality. We hypothesized that DTNPV1 is associated with increased risk of sudden cardiac death (SCD). Methods and Results: This analysis included 15 375 participants (54.1±5.8 years, 45% men, 73% whites) from the Atherosclerosis Risk in Communities (ARIC) study. DTNPV1 was defined from the resting 12-lead ECG as presence of biphasic P wave (positive/negative) in V1 with the amplitude of the terminal negative phase > 100 μV, or one small box on ECG scale. After a median of 14 years of follow-up, 311 cases of SCD occurred. In unadjusted Cox regression, DTNPV1 was associated with an 8-fold increased risk of SCD (HR 8.21; [95%CI 5.27 to 12.79]). Stratified by race and study center, and adjusted for age, sex, coronary heart disease (CHD), and ECG risk factors, as well as atrial fibrillation (AF), stroke, CHD, and heart failure (HF) as time-updated variables, the risk of SCD associated with DTNPV1 remained significant (2.49, [1.51-4.10]). DTNPV1 improved reclassification: additional 3.4% of individuals were appropriately reclassified into a higher SCD risk group, as compared with traditional CHD risk factors alone. In fully adjusted models DTNPV1 was associated with increased risk of non-fatal events: AF (5.02[3.23-7.80]), CHD (2.24[1.43-3.53]), HF (1.90[1.19-3.04]), and trended towards increased risk of stroke (1.88[0.99-3.57]). Conclusion: DTNPV1 is predictive of SCD suggesting its potential utility in risk stratification in the general population.

    Original languageEnglish (US)
    Article number001387
    JournalJournal of the American Heart Association
    Volume3
    Issue number6
    DOIs
    StatePublished - 2014

    Fingerprint

    Sudden Cardiac Death
    Atherosclerosis
    Coronary Disease
    Atrial Fibrillation
    Heart Failure
    Stroke
    Mortality

    Keywords

    • Electrocardiogram
    • Risk stratification
    • Sudden cardiac death

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

    Electrocardiographic deep terminal negativity of the P wave in V1 and risk of sudden cardiac death : The atherosclerosis risk in communities (aric) study. / Tereshchenko, Larisa; Henrikson, Charles; Sotoodehnia, Nona; Arking, Dan E.; Agarwal, Sunil K.; Siscovick, David S.; Post, Wendy S.; Solomon, Scott D.; Coresh, Josef; Josephson, Mark E.; Soliman, Elsayed Z.

    In: Journal of the American Heart Association, Vol. 3, No. 6, 001387, 2014.

    Research output: Contribution to journalArticle

    Tereshchenko, Larisa ; Henrikson, Charles ; Sotoodehnia, Nona ; Arking, Dan E. ; Agarwal, Sunil K. ; Siscovick, David S. ; Post, Wendy S. ; Solomon, Scott D. ; Coresh, Josef ; Josephson, Mark E. ; Soliman, Elsayed Z. / Electrocardiographic deep terminal negativity of the P wave in V1 and risk of sudden cardiac death : The atherosclerosis risk in communities (aric) study. In: Journal of the American Heart Association. 2014 ; Vol. 3, No. 6.
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    title = "Electrocardiographic deep terminal negativity of the P wave in V1 and risk of sudden cardiac death: The atherosclerosis risk in communities (aric) study",
    abstract = "Background: Identifying individuals at risk for sudden cardiac death (SCD) is of critical importance. Electrocardiographic (ECG) deep terminal negativity of P wave in V1 (DTNPV1), a marker of left atrial abnormality, has been associated with increased risk of allcause and cardiovascular mortality. We hypothesized that DTNPV1 is associated with increased risk of sudden cardiac death (SCD). Methods and Results: This analysis included 15 375 participants (54.1±5.8 years, 45{\%} men, 73{\%} whites) from the Atherosclerosis Risk in Communities (ARIC) study. DTNPV1 was defined from the resting 12-lead ECG as presence of biphasic P wave (positive/negative) in V1 with the amplitude of the terminal negative phase > 100 μV, or one small box on ECG scale. After a median of 14 years of follow-up, 311 cases of SCD occurred. In unadjusted Cox regression, DTNPV1 was associated with an 8-fold increased risk of SCD (HR 8.21; [95{\%}CI 5.27 to 12.79]). Stratified by race and study center, and adjusted for age, sex, coronary heart disease (CHD), and ECG risk factors, as well as atrial fibrillation (AF), stroke, CHD, and heart failure (HF) as time-updated variables, the risk of SCD associated with DTNPV1 remained significant (2.49, [1.51-4.10]). DTNPV1 improved reclassification: additional 3.4{\%} of individuals were appropriately reclassified into a higher SCD risk group, as compared with traditional CHD risk factors alone. In fully adjusted models DTNPV1 was associated with increased risk of non-fatal events: AF (5.02[3.23-7.80]), CHD (2.24[1.43-3.53]), HF (1.90[1.19-3.04]), and trended towards increased risk of stroke (1.88[0.99-3.57]). Conclusion: DTNPV1 is predictive of SCD suggesting its potential utility in risk stratification in the general population.",
    keywords = "Electrocardiogram, Risk stratification, Sudden cardiac death",
    author = "Larisa Tereshchenko and Charles Henrikson and Nona Sotoodehnia and Arking, {Dan E.} and Agarwal, {Sunil K.} and Siscovick, {David S.} and Post, {Wendy S.} and Solomon, {Scott D.} and Josef Coresh and Josephson, {Mark E.} and Soliman, {Elsayed Z.}",
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    T1 - Electrocardiographic deep terminal negativity of the P wave in V1 and risk of sudden cardiac death

    T2 - The atherosclerosis risk in communities (aric) study

    AU - Tereshchenko, Larisa

    AU - Henrikson, Charles

    AU - Sotoodehnia, Nona

    AU - Arking, Dan E.

    AU - Agarwal, Sunil K.

    AU - Siscovick, David S.

    AU - Post, Wendy S.

    AU - Solomon, Scott D.

    AU - Coresh, Josef

    AU - Josephson, Mark E.

    AU - Soliman, Elsayed Z.

    PY - 2014

    Y1 - 2014

    N2 - Background: Identifying individuals at risk for sudden cardiac death (SCD) is of critical importance. Electrocardiographic (ECG) deep terminal negativity of P wave in V1 (DTNPV1), a marker of left atrial abnormality, has been associated with increased risk of allcause and cardiovascular mortality. We hypothesized that DTNPV1 is associated with increased risk of sudden cardiac death (SCD). Methods and Results: This analysis included 15 375 participants (54.1±5.8 years, 45% men, 73% whites) from the Atherosclerosis Risk in Communities (ARIC) study. DTNPV1 was defined from the resting 12-lead ECG as presence of biphasic P wave (positive/negative) in V1 with the amplitude of the terminal negative phase > 100 μV, or one small box on ECG scale. After a median of 14 years of follow-up, 311 cases of SCD occurred. In unadjusted Cox regression, DTNPV1 was associated with an 8-fold increased risk of SCD (HR 8.21; [95%CI 5.27 to 12.79]). Stratified by race and study center, and adjusted for age, sex, coronary heart disease (CHD), and ECG risk factors, as well as atrial fibrillation (AF), stroke, CHD, and heart failure (HF) as time-updated variables, the risk of SCD associated with DTNPV1 remained significant (2.49, [1.51-4.10]). DTNPV1 improved reclassification: additional 3.4% of individuals were appropriately reclassified into a higher SCD risk group, as compared with traditional CHD risk factors alone. In fully adjusted models DTNPV1 was associated with increased risk of non-fatal events: AF (5.02[3.23-7.80]), CHD (2.24[1.43-3.53]), HF (1.90[1.19-3.04]), and trended towards increased risk of stroke (1.88[0.99-3.57]). Conclusion: DTNPV1 is predictive of SCD suggesting its potential utility in risk stratification in the general population.

    AB - Background: Identifying individuals at risk for sudden cardiac death (SCD) is of critical importance. Electrocardiographic (ECG) deep terminal negativity of P wave in V1 (DTNPV1), a marker of left atrial abnormality, has been associated with increased risk of allcause and cardiovascular mortality. We hypothesized that DTNPV1 is associated with increased risk of sudden cardiac death (SCD). Methods and Results: This analysis included 15 375 participants (54.1±5.8 years, 45% men, 73% whites) from the Atherosclerosis Risk in Communities (ARIC) study. DTNPV1 was defined from the resting 12-lead ECG as presence of biphasic P wave (positive/negative) in V1 with the amplitude of the terminal negative phase > 100 μV, or one small box on ECG scale. After a median of 14 years of follow-up, 311 cases of SCD occurred. In unadjusted Cox regression, DTNPV1 was associated with an 8-fold increased risk of SCD (HR 8.21; [95%CI 5.27 to 12.79]). Stratified by race and study center, and adjusted for age, sex, coronary heart disease (CHD), and ECG risk factors, as well as atrial fibrillation (AF), stroke, CHD, and heart failure (HF) as time-updated variables, the risk of SCD associated with DTNPV1 remained significant (2.49, [1.51-4.10]). DTNPV1 improved reclassification: additional 3.4% of individuals were appropriately reclassified into a higher SCD risk group, as compared with traditional CHD risk factors alone. In fully adjusted models DTNPV1 was associated with increased risk of non-fatal events: AF (5.02[3.23-7.80]), CHD (2.24[1.43-3.53]), HF (1.90[1.19-3.04]), and trended towards increased risk of stroke (1.88[0.99-3.57]). Conclusion: DTNPV1 is predictive of SCD suggesting its potential utility in risk stratification in the general population.

    KW - Electrocardiogram

    KW - Risk stratification

    KW - Sudden cardiac death

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