A simple electrocardiogram marker for risk stratification of ischemic stroke in low-resources settings.

Background Because of economic constraints, identification of patients at high risk for ischemic stroke who may benefit from further evaluation and aggressive control of their risk factors carries a special importance in low-resources settings. We sought to examine the use of the negative component of the P wave in V 1 in the standard electrocardiogram, referred to as P-wave terminal force (PTF), as a risk stratification tool of ischemic stroke in Africans living in Malawi, a sub-Saharan African country where stroke is a strongly emerging health problem. Methods This was a case-comparison study where 92 patients with ischemic stroke were compared with an equal number of subjects in an age- and sex-matched comparison group. The sensitivity and specificity of abnormal PTF, defined as PTF greater than or equal to 4 mm-s, to diagnose ischemic stroke were calculated. Univariate and multivariable logistic regression analysis was used to estimate the odds of ischemic stroke associated with abnormal PTF. Results Abnormal PTF was present in 54% of patients with stroke compared with only 17% of the comparison group ( P Conclusions PTF greater than or equal to 4 mm-s is associated with the risk of ischemic stroke in Africans independently from ischemic stroke risk factors. Given its reasonable sensitivity and specificity to predict ischemic stroke, PTF greater than or equal to 4 mm-s could be used as a risk stratification tool to discriminate between patients at high and low risk of ischemic stroke, and subsequently identify patients who may benefit from further evaluation and aggressive control of their risk factors.