Association of abnormal p‐wave parameters with brain MRI morphology: The atherosclerosis risk in communities neurocognitive study (ARIC‐NCS)*

Abstract

BackgroundRecent evidence indicates that abnormal P‐wave parameters (PWPs)—ECG markers of atrial myopathy—are associated with incident dementia, independent of atrial fibrillation (AF) and clinical ischemic stroke. However, the mechanisms remain unclear and may include subclinical vascular brain injury. Hence, we evaluated the association of abnormal PWPs with brain MRI correlates of vascular brain injury in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC‐NCS).MethodsARIC‐NCS participants who underwent 3T brain MRI scans in 2011–2013 were included. PWPs were measured from standard 12‐lead ECGs. Brain MRI outcomes included cortical infarcts, lacunar infarcts, cerebral microhemorrhages, brain volumes, and white matter disease (WMD) volume. We used weighted multivariable logistic and linear regression to evaluate the associations of abnormal PWPs with brain MRI outcomes.ResultsAmong 1715 participants (mean age, 76.1 years; 61% women; 29% Black), 797 (46%) had ≥1 abnormal PWP. After multivariable adjustment, including adjusting for prevalent AF, abnormal P‐wave terminal force in lead V1 (aPTFV1) and prolonged P‐wave duration (PPWD) were associated with increased odds of both cortical (OR 1.41; 95% CI, 1.14 to 1.74 and OR 1.30; 95% CI, 1.04 to 1.63, respectively) and lacunar infarcts (OR 1.36; 95% CI, 1.15 to 1.63 and OR 1.37; 95% CI, 1.15 to 1.65, respectively). Advanced interatrial block (aIAB) was associated with higher odds of subcortical microhemorrhage (OR 2.04; 95% CI, 1.36 to 3.06). Other than a significant association between aPTFV1 with lower parietal lobe volume, there were no other significant associations with brain or WMD volume.ConclusionIn this exploratory analysis of a US community‐based cohort, ECG surrogates of atrial myopathy are associated with a higher prevalence of brain infarcts and microhemorrhage, suggesting subclinical vascular brain injury as a possible mechanism underlying the association of atrial myopathy with dementia.

Subclinical variations on ECG and their associations with structural brain aging networks

“…The resulting neurovascular dysfunction and inflammation can impair glymphatic clearance and exacerbate existing AD pathology leading to synaptic dysfunction and eventually brain atrophy (Moore and Jefferson 2021). A recent study by (Reyes et al 2023) found an association between prolonged PWD and various cerebrovascular related injuries, but not with gross lobar volumes. We, on the other hand, found a significant association between short PWD and accelerated brain aging.…”

“…Anomalies in PWD, whether shorter or longer than the norm, are believed to reflect structural or physiological alterations in the left or right atria. These subtle variations thus provide markers of cardiac pathology and can serve as early indicators of various cardiovascular diseases, including AF and other arrhythmias, cardiovascular risk factors and related deaths (He et al 2017, Nielsen et al 2015, Magnani et al 2009, Kosar et al 2008, Uyarel et al 2005, Magnani et al 2015, and more recently dementia (Gutierrez et al, 2019) and cerebrovascular-related injuries (Reyes et al 2023).…”