Abstract P009: P Wave Indices Enhance Risk Prediction of Atrial Fibrillation but not Heart Failure or Mortality: The Atherosclerosis Risk in Communities Study
Introduction. Abnormal P wave indices (PWI) have been related to atrial fibrillation (AF) and mortality. Whether they enhance risk prediction has not been assessed. We examined the relations of PWI (P wave duration, area, and terminal force) to 10-year risk of AF, heart failure and mortality, and determined their contributions toward enhancing prediction.
Methods. We quantified PWI from participants attending ARIC Study visit 4 (1996-98). Participants with AF/flutter, Wolff-Parkinson-White, AV nodal medications, or missing covariates were excluded. AF and heart failure were derived by hospital discharge coding. We determined the associations between PWIs and the outcomes in multivariable-adjusted models. We assessed the contribution of each PWI to the net reclassification index (NRI) and integrated discrimination improvement (IDI).
Results. Following exclusions, 8254 participants were eligible for the AF analysis and 8201 participants for the heart failure and mortality analyses. We identified 458 cases of incident AF and found significant quadratic associations between maximum and mean P wave area and duration and AF, and significant linear associations between P wave terminal force and AF. There were 462 cases of heart failure. We found a significant quadratic association between maximum P wave area and heart failure and a significant linear association between P wave terminal force and heart failure. There were 849 deaths. Only P wave terminal force was significantly associated with mortality. The Table summarizes the c-statistic, NRI, and IDI across models incorporating the relevant PWI. Compared to the base models, PWI did not contribute to risk reclassification. PWI resulted in significant but marginal IDI increase for AF but not for heart failure or mortality.
Conclusions. In this study examining the 10-year risk of AF, heart failure and mortality in ARIC participants, PWI had a limited contribution towards enhancing risk prediction for AF but not heart failure or mortality over traditional risk factors.
- © 2013 by American Heart Association, Inc.