The Clinical Study Of P Wave Terminal Negative Wave Parameters In Lead V1 Predicting Cardiogenic Cerebral Infarction In Patients With Paroxysmal Atrial Fibrillation

BackgroundAtrial fibrillation（AF）is an important risk factor for stroke.Stratifying the risk of stroke in patients with AF based on the CHA₂DS₂-VASc score is an important step in preventing stroke in AF patients.Recent studies have shown that potential atrial fibrosis and atrial dysfunction may also contribute to the occurrence of stroke in AF patients.At the same time,evidence-based studies have shown that the clinical use of the CHA₂DS₂-VASc score to predict the risk of stroke has certain limitations,which is related to the lack of elements reflecting left atrial remodeling.The Parameters of Terminal Negative P-wave in Lead V1 are indicators reflecting left atrial structure and electrophysiological abnormalities,which are associated with left atrial remodeling,cardiovascular disease,and cognitive impairment.The latest research shows that the Parameters of Terminal Negative P-wave in Lead V1 may be correlated with acute ischemic stroke.However,its role in cardioembolic stroke is still unclear.ObjectiveTo obtain the parameters of terminal negative P-wave in lead V1 of the standard12-lead surface electrocardiogram,including P-Wave Terminal Force in Lead V1（PTFV1）,P-prime Amplitude in Lead V1（PPa V1）,and P-prime Duration in Lead V1（PPd V1）,and to analyze their correlation and predictive value for the occurrence of acute cardiogenic ischemic stroke in patients with paroxysmal atrial fibrillation.MethodsA total of 68 patients with paroxysmal atrial fibrillation who had suffered from cardioembolic stroke were consecutively collected from the Cardiology and Neurology departments of Subei Hospital between January 1st,2018 and December 31st,2022.Additionally,a total of 340 patients with paroxysmal atrial fibrillation who did not have a history of stroke were collected in a 1:5 ratio.All stroke patients were diagnosed with cardioembolic stroke based on the TOAST classification system,and required confirmation via head CT/MRI within 48 hours of onset.The parameters of terminal negative P-wave in lead V1 were collected using a 12-lead surface electrocardiogram,including P-Wave Terminal Force in Lead V1（PTFV1）,P-prime Amplitude in Lead V1（PPa V1）,and P-prime Duration in Lead V1（PPd V1）.The stroke volume was calculated using the Pullicino formula.General clinical data including age,gender,Body Mass Index（BMI）,CHA₂DS₂-VASc score,and hypertension history were collected for all patients.Data statistics and analysis were performed using SPSS 25.0 statistical software.Independent samples t-test or chi-square test were used to compare the differences in baseline data between the group of patients with paroxysmal atrial fibrillation who had cerebral infarction and the group who did not have cerebral infarction;binary logistic regression model was used to analyze the independent related factors of cerebral infarction in patients with paroxysmal atrial fibrillation;receiver operating characteristic curve（ROC curve）was used to determine the predictive value of the parameters of terminal negative P-wave in lead V1 for cerebral infarction in patients with paroxysmal atrial fibrillation;one-way analysis of variance was used to explore the correlation between the parameters of terminal negative P-wave in lead V1 and different infarction volumes.ROC curve was used to analyze the predictive value of the parameters of terminal negative P-wave in lead V1 for infarction volume.Results1.The parameters of terminal negativity P-wave in lead V1（PTFV1,PPa V1,PPd V1）in patients with AF and ischemic stroke were higher than those in patients with AF without stroke,and the difference was statistically significant（P<0.05）.2.Multivariate analysis showed that independent risk factors for ischemic stroke in patients with AF included PTFV1（OR=2.890）,CHA2DS2-VASc score（OR=3.338）,age（OR=1.050）,P-wave duration（OR=1.454）,and left atrial appendage opening width（OR=1.490）,all of which were statistically significant（P<0.05）.3.3.The combined index of the parameters of terminal negativity P-wave in lead V1and CHA₂DS₂-VASc score significantly increased the predictive accuracy of CHA₂DS₂-VASc score for ischemic stroke in patients with AF,with an area under the ROC curve of 0.821（P<0.001;95%CI,0.769-0.872）.4.4.The relationship between PTFV1,PPa V1,PPd V1 and different volumes of infarction was compared.The results showed that PPd V1 and PTFV1 in the large volume infarction group were significantly higher than those in the small and medium volume infarction groups,and the difference was statistically significant（P<0.001）.5.PTFV1 and PPd V1 in patients with AF and ischemic stroke were positively correlated with the volume of infarction（r=0.731 and r=0.615,respectively,P<0.05）,while PPa V1was not correlated with the volume of infarction（r=0.227,P>0.05）.Conclusion1.In patients with paroxysmal atrial fibrillation,The parameters of terminal negativity P-wave in lead V1 is an independent risk factor for cerebral infarction.2.The combined index of the parameters of terminal negativity P-wave in l ead V1 and CHA2DS2-VASc score can significantly improve the predictive value of CHA2DS2-VASc score for cerebral infarction in patients with paroxysmal atrial fibrillation.3.The parameters of terminal negativity P-wave in lead V1,PTFV1 and PPd V1 are positively correlated with the volume of cerebral infarction in patients with paroxysmal atrial fibrillation.