Electrocardiographic Morphology-Voltage-P-Wave-Duration (MVP) Score to Select Patients for Continuous Atrial Fibrillation Screening to Prevent Stroke

Abstract

Morphology-voltage-P-wave-duration (MVP) score combining P-wave duration (PWD), P-wave voltage in lead I (PWVI), and interatrial block (IAB) has been demonstrated to predict atrial fibrillation (AF). Therefore, this study aimed to examine MVP score and its P-wave components as potential predictors of AF screening effects on stroke prevention. This was a secondary analysis of the LOOP Study (Atrial Fibrillation detected by Continuous ECG Monitoring using Implantable Loop Recorder to prevent Stroke in High-risk Individuals) which randomized older persons (aged 70 to 90 years) with additional stroke risk factors to either continuous monitoring with implantable loop recorder and anticoagulation upon detection of AF episodes ≥6 minutes (the intervention group), or usual care. A total of 5,759 participants were included in the present analysis, where PWD, PWVI, and IAB were determined through a computerized analysis of 12-lead electrocardiogram and further employed to calculate baseline MVP score (0 to 6) for each participant. In total, 305 (5.3%) had stroke or systemic embolism during follow-up, with a higher risk in the group with MVP score 5 to 6 than those having score 0 to 2 (hazard ratio (HR) 1.54 [95% confidence interval (CI) 1.01 to 2.35]). This risk increase was mainly upheld by participants with IAB (HR 1.62 [95% CI 1.11 to 2.36] for IAB vs no IAB) and with longer PWD (HR 1.37 [95% CI 1.07 to 1.75] for >110 vs ≤110 ms). Compared with usual care, implantable loop recorder screening did not significantly reduce the risk of stroke or systemic embolism in any MVP risk categories (HR 0.80 [95% CI 0.60 to 1.08] for MVP score 0 to 2, 0.54 [95% CI 0.16 to 1.85] for MVP score 3 to 4, and 0.89 [95% CI 0.35 to 2.25] for MVP score 5 to 6; pinteraction = 0.78). In conclusion, a higher MVP score was associated with an increased stroke risk, but it did not demonstrate an association with effects of AF screening on stroke prevention. These findings should be considered hypothesis-generating and warrant further study. Morphology-voltage-P-wave-duration (MVP) score combining P-wave duration (PWD), P-wave voltage in lead I (PWVI), and interatrial block (IAB) has been demonstrated to predict atrial fibrillation (AF). Therefore, this study aimed to examine MVP score and its P-wave components as potential predictors of AF screening effects on stroke prevention. This was a secondary analysis of the LOOP Study (Atrial Fibrillation detected by Continuous ECG Monitoring using Implantable Loop Recorder to prevent Stroke in High-risk Individuals) which randomized older persons (aged 70 to 90 years) with additional stroke risk factors to either continuous monitoring with implantable loop recorder and anticoagulation upon detection of AF episodes ≥6 minutes (the intervention group), or usual care. A total of 5,759 participants were included in the present analysis, where PWD, PWVI, and IAB were determined through a computerized analysis of 12-lead electrocardiogram and further employed to calculate baseline MVP score (0 to 6) for each participant. In total, 305 (5.3%) had stroke or systemic embolism during follow-up, with a higher risk in the group with MVP score 5 to 6 than those having score 0 to 2 (hazard ratio (HR) 1.54 [95% confidence interval (CI) 1.01 to 2.35]). This risk increase was mainly upheld by participants with IAB (HR 1.62 [95% CI 1.11 to 2.36] for IAB vs no IAB) and with longer PWD (HR 1.37 [95% CI 1.07 to 1.75] for >110 vs ≤110 ms). Compared with usual care, implantable loop recorder screening did not significantly reduce the risk of stroke or systemic embolism in any MVP risk categories (HR 0.80 [95% CI 0.60 to 1.08] for MVP score 0 to 2, 0.54 [95% CI 0.16 to 1.85] for MVP score 3 to 4, and 0.89 [95% CI 0.35 to 2.25] for MVP score 5 to 6; pinteraction = 0.78). In conclusion, a higher MVP score was associated with an increased stroke risk, but it did not demonstrate an association with effects of AF screening on stroke prevention. These findings should be considered hypothesis-generating and warrant further study. Atrial fibrillation (AF), as the most common sustained cardiac arrhythmia, is a well-known risk factor for stroke.1Wolf PA Abbott RD Kannel WB Atrial fibrillation as an independent risk factor for stroke: the Framingham study.Stroke. 1991; 22: 983-988Crossref PubMed Google Scholar,2Lip GYH Lane DA Stroke prevention in atrial fibrillation: a systematic review.JAMA. 2015; 313: 1950-1962Crossref PubMed Scopus (235) Google Scholar Due toadvancing technology for heart rhythm monitoring and growing evidence on high prevalence of asymptomatic AF,3Healey JS Connolly SJ Gold MR Israel CW Van Gelder IC Capucci A Lau CP Fain E Yang S Bailleul C Morillo CA Carlson M Themeles E Kaufman ES Hohnloser SH ASSERT InvestigatorsSubclinical atrial fibrillation and the risk of stroke.N Engl J Med. 2012; 366: 120-129Crossref PubMed Scopus (1525) Google Scholar,4Hindricks G Potpara T Dagres N Arbelo E Bax JJ Blomström-Lundqvist C Boriani G Castella M Dan GA Dilaveris PE Fauchier L Flippatos G Kalman JM La Meir M Lane DA Lebeau JP Lettino M Lip GYH Pinto FJ Thomas GN Valgimigli M Van Gelder IC Van Putte BP Watkins CL ESC Scientific Document Group2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2021; 42: 373-498Crossref PubMed Scopus (4244) Google Scholar a substantial interest has arisen in screening for AF. However, data on health benefits from AF screening and the optimal screening strategies are scarce.4Hindricks G Potpara T Dagres N Arbelo E Bax JJ Blomström-Lundqvist C Boriani G Castella M Dan GA Dilaveris PE Fauchier L Flippatos G Kalman JM La Meir M Lane DA Lebeau JP Lettino M Lip GYH Pinto FJ Thomas GN Valgimigli M Van Gelder IC Van Putte BP Watkins CL ESC Scientific Document Group2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2021; 42: 373-498Crossref PubMed Scopus (4244) Google Scholar,5Davidson KW Barry MJ Mangione CM Cabana M Caughey AB Davis EM Donahue KE Doubeni CA Epling JW Kubik M Li L Ogedegbe G Pbert L Silverstein M Stevermer J Tseng CW Wong JB United States Preventive Services Task ForceScreening for atrial fibrillation: US Preventive Services Task Force recommendation statement.JAMA. 2022; 327: 360-367Crossref Scopus (71) Google Scholar Morphology-Voltage-P-wave-duration (MVP) risk score that combines 3 P-wave parameters is a newly proposed risk stratification tool and has demonstrated to predict AF in different patient populations.6Alexander B Milden J Hazim B Haseeb S Bayes-Genis A Elosua R Martínez-Sellés M Yeung C Hopman W Bayes de Luna A Baranchuk A New electrocardiographic score for the prediction of atrial fibrillation: the MVP ECG risk score (morphology-voltage-P-wave duration).Ann Noninvasive Electrocardiol. 2019; 24: e12669Crossref PubMed Scopus (30) Google Scholar, 7Hayıroğlu Mİ Çınar T Selçuk M Çinier G Alexander B Doğan S Çiçek V Kılıç Ş Atmaca MM Orhan AL Baranchuk A The significance of the morphology-voltage-P-wave duration (MVP) ECG score for prediction of and atrial fibrillation in Electrocardiol. 2021; Scopus Google Scholar, N N G Yang M S of duration (MVP) score as a of atrial fibrillation Noninvasive Electrocardiol. Scopus Google Scholar parameters from the P-wave in a 12-lead electrocardiogram been and in AF prediction J JS B P-wave in lead I is associated with and of atrial fibrillation PubMed Scopus Google Scholar, B Haseeb S Van G Hopman W M Luna AB Çinier G Baranchuk A P-wave voltage in lead I is associated with of atrial fibrillation in with Google Scholar, A interatrial block and atrial fibrillation risk in the J PubMed Google Scholar, J C A A C S L JB prediction of atrial fibrillation on electrocardiographic interatrial Heart Scopus (30) Google Scholar, JB A C B JJ S L P-wave duration and the risk of atrial fibrillation: from the ECG 2015; PubMed Scopus Google Scholar, JW duration and risk of atrial fibrillation in persons the Framingham heart J Scopus Google Scholar, S C JB A L of atrial fibrillation detected by implantable loop from the LOOP Scopus Google Scholar Therefore, this risk score be in for AF screening and In this to examine the MVP risk score and its P-wave components for prediction of AF and stroke as as AF screening The LOOP study (Atrial Fibrillation detected by Continuous ECG Monitoring using Implantable Loop Recorder to prevent Stroke in High-risk Individuals) was a to AF screening by continuous ECG monitoring using implantable loop recorder The was and by the and study participants and of the study and been S C C JB A L Implantable loop recorder detection of atrial fibrillation to prevent stroke LOOP a 2021; PubMed Google Scholar, L S A C C JB Atrial fibrillation detected by continuous electrocardiographic monitoring using implantable loop recorder to prevent stroke in risk (the LOOP and of a randomized Heart J. PubMed Scopus Google Scholar In persons and with additional stroke risk factor heart or stroke were from the and randomized in a ratio to screening or usual care. The was in and a 12-lead ECG was in participants In the any AF episodes ≥6 minutes were by 2 and anticoagulation was upon of AF In the data on AF diagnosis were from the In this secondary analysis, included the LOOP participants with 12-lead ECG baseline and further those had an ECG with rhythm or findings for of P-wave parameters atrial and and using the ECG an MVP ECG risk score for each (0 to was on the P-wave in the and the voltage and duration of the P-wave from 12-lead The P-wave duration (PWD), P-wave voltage in lead I (PWVI), and interatrial block (IAB) was from the computerized analysis of baseline 12-lead for The MVP score from 0 to where 0 to 2 is as AF risk, 3 to as AF risk, and 5 to 6 as high AF B Milden J Hazim B Haseeb S Bayes-Genis A Elosua R Martínez-Sellés M Yeung C Hopman W Bayes de Luna A Baranchuk A New electrocardiographic score for the prediction of atrial fibrillation: the MVP ECG risk score (morphology-voltage-P-wave duration).Ann Noninvasive Electrocardiol. 2019; 24: e12669Crossref PubMed Scopus (30) Google (MVP) risk voltage in lead in interatrial interatrial P-wave parameters were using data from baseline 12-lead block was as P-wave duration with the of P-wave in any interatrial block was as P-wave duration with in in a The P-wave parameters were using data from baseline 12-lead block was as P-wave duration with the of P-wave in any interatrial block was as P-wave duration with in The in the present study was a of stroke or systemic embolism the secondary were the of or and AF The of and was by a as L S A C C JB Atrial fibrillation detected by continuous electrocardiographic monitoring using implantable loop recorder to prevent stroke in risk (the LOOP and of a randomized Heart J. PubMed Scopus Google Scholar analysis, the study participants were different to MVP risk (0 to 2 vs 3 to vs 5 to PWD vs to vs vs to vs and IAB baseline IAB vs IAB vs are as with for continuous and with for The were by and the study were as with and are as with confidence are using the with as a The of with MVP score and its P-wave components were using for and baseline heart heart heart and and are as ratio (HR) with confidence PWD and were further as continuous using in the where the were with the as The effects of screening vs usual were to MVP PWD, PWVI, and IAB in the and the parameters were by an the The screening effects were to PWD and as continuous using to effects on the of the in each The for screening effects were in with the were to the and any this were with stratification to different baseline data were using R R for The significance was a LOOP study participants = were from this secondary analysis to baseline ECG = or ECG with findings for = The study 5,759 with a of of had an MVP risk score of to 2, no was a score of 0 to AF risk categories on MVP score are in with higher MVP score were to be and had a higher and a higher was no in heart score 3 risk and the was for most baseline of baseline to Morphology-Voltage-P-wave-duration (MVP) risk risk = risk = risk = = score heart heart heart parameters P-wave P-wave voltage in lead block interatrial interatrial was on MVP score where score 0 to 2 as risk, 3 to as risk, and 5 to 6 as high block was as P-wave duration with the of P-wave in any interatrial block was as P-wave duration with in = = in a was on MVP score where score 0 to 2 as risk, 3 to as risk, and 5 to 6 as high block was as P-wave duration with the of P-wave in any interatrial block was as P-wave duration with in = = 5,759 participants 305 (5.3%) had during AF risk categories in the study the of the was higher in the group to and the group to than in the group to but the risk increase in the group the significance (HR 1.54 to were for the secondary of with a significantly higher in the group than in the group (HR to The for the of were increased in the and The and of the are in the are in and of to Morphology-Voltage-P-wave-duration (MVP) risk score and its voltage in lead risk or systemic of participants had a P-wave voltage in lead I baseline [95% confidence were and are in [95% confidence were determined in for heart heart heart and was on MVP score where score 0 to 2 as risk, 3 to as risk, and 5 to 6 as high block was as P-wave duration with the of in any interatrial block was as P-wave duration with in of participants had a P-wave voltage in lead I baseline [95% confidence were and are in [95% confidence were determined in for heart heart heart and was on MVP score where score 0 to 2 as risk, 3 to as risk, and 5 to 6 as high block was as P-wave duration with the of in any interatrial block was as P-wave duration with in interatrial interatrial of participants had a P-wave voltage in lead I baseline [95% confidence were and are in [95% confidence were determined in for heart heart heart and was on MVP score where score 0 to 2 as risk, 3 to as risk, and 5 to 6 as high block was as P-wave duration with the of in any interatrial block was as P-wave duration with in of participants had a P-wave voltage in lead I baseline [95% confidence were and are in [95% confidence were determined in for heart heart heart and was on MVP score where score 0 to 2 as risk, 3 to as risk, and 5 to 6 as high block was as P-wave duration with the of in any interatrial block was as P-wave duration with in interatrial interatrial systemic or of participants had a P-wave voltage in lead I baseline [95% confidence were and are in [95% confidence were determined in for heart heart heart and was on MVP score where score 0 to 2 as risk, 3 to as risk, and 5 to 6 as high block was as P-wave duration with the of in any interatrial block was as P-wave duration with in of participants had a P-wave voltage in lead I baseline [95% confidence were and are in [95% confidence were determined in for heart heart heart and was on MVP score where score 0 to 2 as risk, 3 to as risk, and 5 to 6 as high block was as P-wave duration with the of in any interatrial block was as P-wave duration with in interatrial interatrial of participants had a P-wave voltage in lead I [95% confidence were and are in [95% confidence were determined in for heart heart heart and was on MVP score where score 0 to 2 as risk, 3 to as risk, and 5 to 6 as high block was as P-wave duration with the of in any interatrial block was as P-wave duration with in in a the P-wave components of the MVP risk the of IAB was associated with significantly increased of (HR 1.62 to stroke (HR to and (HR to in the with no P-wave participants with were significantly of stroke and than those with higher (HR to and to The association were present was as a continuous PWD, the risk of and were in participants with PWD of to and with PWD with those having a duration as a continuous the of and stroke demonstrated a with PWD, as in with a of PWD >110 significantly higher of (HR 1.37 to and stroke (HR to than those with follow-up, AF was in of participants in the group and of participants in the In the participants with MVP score 5 to 6 were to AF than those with score 0 to 2 (HR to each of the P-wave components PWD and the of IAB were associated with increased AF risk in the group (HR to to and to were present in the further AF as a potential for the of the with MVP risk categories and its P-wave a analysis was by AF as a during in and of in the for AF. 3 the screening effects to the MVP risk score and its P-wave were no screening effects and MVP risk PWD or IAB for screening did not significantly reduce the of and in any of MVP risk PWD, PWVI, or the of were PWD and were as continuous This is the study to ECG parameters for prediction of AF screening effects on stroke prevention. In an older with additional stroke risk study 2 higher MVP ECG risk longer PWD, and the of IAB in 12-lead ECG were associated with increased of AF and with a higher risk of AF were stroke and MVP risk score its P-wave components predict effects of screening for AF. is evidence that AF an increased stroke JS Connolly SJ Gold MR Israel CW Van Gelder IC Capucci A Lau CP Fain E Yang S Bailleul C Morillo CA Carlson M Themeles E Kaufman ES Hohnloser SH ASSERT InvestigatorsSubclinical atrial fibrillation and the risk of stroke.N Engl J Med. 2012; 366: 120-129Crossref PubMed Scopus (1525) Google R T S DA A Kalman JM Lau atrial fibrillation and stroke A systematic and Heart J. PubMed Scopus Google Scholar but data health benefits from AF screening are scarce.4Hindricks G Potpara T Dagres N Arbelo E Bax JJ Blomström-Lundqvist C Boriani G Castella M Dan GA Dilaveris PE Fauchier L Flippatos G Kalman JM La Meir M Lane DA Lebeau JP Lettino M Lip GYH Pinto FJ Thomas GN Valgimigli M Van Gelder IC Van Putte BP Watkins CL ESC Scientific Document Group2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2021; 42: 373-498Crossref PubMed Scopus (4244) Google Scholar,5Davidson KW Barry MJ Mangione CM Cabana M Caughey AB Davis EM Donahue KE Doubeni CA Epling JW Kubik M Li L Ogedegbe G Pbert L Silverstein M Stevermer J Tseng CW Wong JB United States Preventive Services Task ForceScreening for atrial fibrillation: US Preventive Services Task Force recommendation statement.JAMA. 2022; 327: 360-367Crossref Scopus (71) Google Scholar 2 randomized AF screening for stroke prevention. The analysis of the LOOP study a in stroke risk by S C C JB A L Implantable loop recorder detection of atrial fibrillation to prevent stroke LOOP a 2021; PubMed Google Scholar the ECG for Atrial Fibrillation in the of and study ECG screening for 2 in a a of the of and effects on any of E L V J M in systematic screening for atrial fibrillation a 2021; PubMed Google Scholar this it to those to In this 12-lead ECG be of to as ECG parameters are and of of parameters been to an increased risk of AF B Haseeb S Van G Hopman W M Luna AB Çinier G Baranchuk A P-wave voltage in lead I is associated with of atrial fibrillation in with Google Scholar, A interatrial block and atrial fibrillation risk in the J PubMed Google Scholar, J C A A C S L JB prediction of atrial fibrillation on electrocardiographic interatrial Heart Scopus (30) Google Scholar, JB A C B JJ S L P-wave duration and the risk of atrial fibrillation: from the ECG 2015; PubMed Scopus Google Scholar, JW duration and risk of atrial fibrillation in persons the Framingham heart J Scopus Google Scholar, S C JB A L of atrial fibrillation detected by implantable loop from the LOOP Scopus Google Scholar MVP ECG risk score is a newly proposed risk stratification tool the of the and the duration of P-wave in 12-lead ECG to AF B Milden J Hazim B Haseeb S Bayes-Genis A Elosua R Martínez-Sellés M Yeung C Hopman W Bayes de Luna A Baranchuk A New electrocardiographic score for the prediction of atrial fibrillation: the MVP ECG risk score (morphology-voltage-P-wave duration).Ann Noninvasive Electrocardiol. 2019; 24: e12669Crossref PubMed Scopus (30) Google Scholar PWD and IAB are risk for AF in A interatrial block and atrial fibrillation risk in the J PubMed Google Scholar, J C A A C S L JB prediction of atrial fibrillation on electrocardiographic interatrial Heart Scopus (30) Google Scholar, JB A C B JJ S L P-wave duration and the risk of atrial fibrillation: from the ECG 2015; PubMed Scopus Google Scholar, JW duration and risk of atrial fibrillation in persons the Framingham heart J Scopus Google Scholar is a P-wave where voltage had been demonstrated to be associated with AF in with heart and with AF in J JS B P-wave in lead I is associated with and of atrial fibrillation PubMed Scopus Google B Haseeb S Van G Hopman W M Luna AB Çinier G Baranchuk A P-wave voltage in lead I is associated with of atrial fibrillation in with Google Scholar In an association was MVP score and AF risk in B Milden J Hazim B Haseeb S Bayes-Genis A Elosua R Martínez-Sellés M Yeung C Hopman W Bayes de Luna A Baranchuk A New electrocardiographic score for the prediction of atrial fibrillation: the MVP ECG risk score (morphology-voltage-P-wave duration).Ann Noninvasive Electrocardiol. 2019; 24: e12669Crossref PubMed Scopus (30) Google Scholar, 7Hayıroğlu Mİ Çınar T Selçuk M Çinier G Alexander B Doğan S Çiçek V Kılıç Ş Atmaca MM Orhan AL Baranchuk A The significance of the morphology-voltage-P-wave duration (MVP) ECG score for prediction of and atrial fibrillation in Electrocardiol. 2021; Scopus Google Scholar, N N G Yang M S of duration (MVP) score as a of atrial fibrillation Noninvasive Electrocardiol. Scopus Google Scholar study that participants with higher MVP were higher risk of AF which the increased stroke risk in This increase in stroke risk further to be upheld by those with IAB and with longer PWD in baseline 12-lead that PWD and IAB to J C A A C S L JB prediction of atrial fibrillation on electrocardiographic interatrial Heart Scopus (30) Google JB A C B JJ S L P-wave duration and the risk of atrial fibrillation: from the ECG 2015; PubMed Scopus Google J G S Li G Lip GYH T P-wave and risk of stroke: A systematic and PubMed Scopus Google Scholar However, an from study was the stroke risk in participants with a significantly higher AF A in ECG is to interatrial through the proposed to as a study by J JS B P-wave in lead I is associated with and of atrial fibrillation PubMed Scopus Google Scholar of interatrial in AF with using Therefore, was to be a risk for a of using for risk stratification to AF P-wave voltage in the and a study demonstrated atrial in AF to be associated with SH SH of atrial on in with atrial Med. 2022; Scopus Google Scholar this be a for the AF and stroke risk with to PWVI, but further are to the for the with AF and the effects of screening on stroke prevention did not with MVP risk PWD, or IAB in the present study. in the of the LOOP S C C JB A L Implantable loop recorder detection of atrial fibrillation to prevent stroke LOOP a 2021; PubMed Google Scholar the screening effects were in participants with higher MVP risk with longer PWD, and with The of on AF screening higher stroke be by findings that the of stroke with MVP score and its P-wave components were not by AF. the P-wave parameters were not risk for be for persons to from AF This is with a by G L J L S association study associated with atrial and Heart J. 2021; 42: Scopus Google Scholar a association of atrial with stroke than with AF. further the of atrial atrial that in and as the for AF and G Potpara T Dagres N Arbelo E Bax JJ Blomström-Lundqvist C Boriani G Castella M Dan GA Dilaveris PE Fauchier L Flippatos G Kalman JM La Meir M Lane DA Lebeau JP Lettino M Lip GYH Pinto FJ Thomas GN Valgimigli M Van Gelder IC Van Putte BP Watkins CL ESC Scientific Document Group2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2021; 42: 373-498Crossref PubMed Scopus (4244) Google Arbelo E Boriani G S CM B W Dagres N de M L L C L B L A E JS G T M C T Lip GYH W S R L L T M J Potpara diagnosis and rhythm management to in with atrial fibrillation: the Scopus Google Scholar In this PWD and the of IAB in 12-lead ECG be potential of atrial that to stroke in the of AF. This the effects of AF screening and in study. the of atrial and the of its for is and evidence from G Potpara T Dagres N Arbelo E Bax JJ Blomström-Lundqvist C Boriani G Castella M Dan GA Dilaveris PE Fauchier L Flippatos G Kalman JM La Meir M Lane DA Lebeau JP Lettino M Lip GYH Pinto FJ Thomas GN Valgimigli M Van Gelder IC Van Putte BP Watkins CL ESC Scientific Document Group2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2021; 42: 373-498Crossref PubMed Scopus (4244) Google Arbelo E Boriani G S CM B W Dagres N de M L L C L B L A E JS G T M C T Lip GYH W S R L L T M J Potpara diagnosis and rhythm management to in with atrial fibrillation: the Scopus Google Scholar The present study has the of this secondary analysis should be considered as the the of study to those the from the to study older persons 70 to 90 and of mainly which the of findings to and In conclusion, in an older with additional stroke risk the P-wave parameters and the MVP risk score from 12-lead ECG were associated with but did not demonstrate an association with effects of AF screening on stroke prevention. with stroke were not by which be a for the to predict screening These findings should be considered hypothesis-generating and warrant further study. to be a of and to and from in to this and this a of and not to this to be a an of this from The of and The of The of and from and and a from not to this from and not to this The no to Dan and and for in the of the LOOP the and in the of and and with the of the LOOP with

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