Abstract 16711: Left Atrial Abnormality is Associated With Greater Cognitive Decline Independent of Atrial Fibrillation: The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS)
Introduction: Atrial fibrillation (AF) is associated with greater cognitive decline. Abnormal P-wave terminal force in ECG lead V1 (PTFV1)—a marker of left atrial (LA) abnormality—is associated with stroke and subclinical vascular brain injury, independent of AF.
Hypothesis: We hypothesized that abnormal PTFV1 is associated with greater cognitive decline, independent of AF in ARIC-NCS, a biracial community-based prospective cohort study.
Methods: We analyzed data from 10,837 participants (mean age in 1990-92, 57 ± 6 years; 56% women; and 22% black) who had cognitive tests performed in 1990-92 (baseline) and at least 1 of the following visits: 1996-98 or 2011-13. Abnormal PTFV1 was defined as ≥4,000 μV*ms and obtained from digital study ECGs using automated software. AF was ascertained from hospital discharge diagnosis codes and study ECGs. Generalized estimating equations were used to assess the association between time-dependent PTFV1 and change in z-scores of cognitive tests.
Results: At baseline, 1,316 (12%) participants had abnormal PTFV1 and by 1996-98 an additional 751 participants had developed abnormal PTFV1. During mean follow-up of 14 years, there were 1,703 incident AF cases. Abnormal PTFV1 was associated with greater decline in Delayed Word Recall and Word Fluency, but not Digit Symbol Substitution (Table). After adjusting for time-dependent AF, the associations were unchanged.
Conclusions: Abnormal PTFV1 is associated with greater cognitive decline independent of development of AF. Further research using more direct measures of atrial anatomy and function (e.g., echocardiographic LA enlargement and dysfunction) is needed to evaluate the role of LA abnormality in cognitive decline.
Author Disclosures: L.Y. Chen: None. F.L. Norby: None. R.F. Gottesman: None. T.H. Mosley: None. A.R. Folsom: None. H. Kamel: None. E.Z. Soliman: None. A. Alonso: None.
- © 2016 by American Heart Association, Inc.