{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T03:39:16Z","timestamp":1772163556254,"version":"3.50.1"},"reference-count":74,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T00:00:00Z","timestamp":1630627200000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services","award":["HL118277"],"award-info":[{"award-number":["HL118277"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,8,16]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The goal of the study was to determine an association of cardiac ventricular substrate with thrombotic stroke (TS), cardioembolic stroke (ES) and intracerebral haemorrhage (ICH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The Atherosclerosis Risk in Communities (ARIC) study in 1987\u20131989 enrolled adults (45\u201364 years), selected as a probability sample from four US communities (Minneapolis, Minnesota; Washington, Maryland; Forsyth, North Carolina; Jackson, Mississippi). Visit 2 was in 1990\u20131992, visit 3 in 1993\u20131995, visit 4 in 1996\u20131998 and visit 5 in 2011\u20132013.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>ARIC participants with analysable ECGs and no history of stroke were included (n=14\u2009479; age 54\u00b16\u2009y; 55% female; 24% black). Ventricular substrate was characterised by cardiac memory, spatial QRS-T angle (QRS-Ta), sum absolute QRST integral (SAIQRST), spatial ventricular gradient magnitude (SVGmag), premature ventricular contractions (PVCs) and tachycardia-dependent intermittent bundle branch block (TD-IBBB) on 12-lead ECG at visits 1\u20135.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome<\/jats:title>\n                    <jats:p>Adjudicated TS included a first definite or probable thrombotic cerebral infarction, ES\u2014a first definite or probable non-carotid cardioembolic brain infarction. Definite ICH was included if it was the only stroke event.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Over a median 24.5 years follow-up, there were 899 TS, 400 ES and 120 ICH events. Cox proportional hazard risk models were adjusted for demographics, cardiovascular disease, risk factors, atrial fibrillation, atrial substrate and left ventricular hypertrophy. After adjustment, PVCs (HR 1.72; 95%\u2009CI 1.02 to 2.92), QRS-Ta (HR 1.15; 95%\u2009CI 1.03 to 1.28), SAIQRST (HR 1.20; 95%\u2009CI 1.07 to 1.34) and time-updated SVGmag (HR 1.19; 95%\u2009CI 1.08 to 1.32) associated with ES. Similarly, PVCs (HR 1.53; 95%\u2009CI 1.03 to 2.26), QRS-Ta (HR 1.08; 95%\u2009CI 1.01 to 1.16), SAIQRST (HR 1.07; 95%\u2009CI 1.01 to 1.14) and time-updated SVGmag (HR 1.11; 95%\u2009CI 1.04 to 1.19) associated with TS. TD-IBBB (HR 3.28; 95%\u2009CI 1.03 to 10.46) and time-updated SVGmag (HR 1.23; 95%\u2009CI 1.03 to 1.47) were associated with ICH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>PVC burden (reflected by cardiac memory) is associated with ischaemic stroke. Transient cardiac memory (likely through TD-IBBB) precedes ICH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-048542","type":"journal-article","created":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T12:19:42Z","timestamp":1630671582000},"page":"e048542","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Electrophysiological ventricular substrate of stroke: a prospective cohort study in the Atherosclerosis Risk in Communities (ARIC) study"],"prefix":"10.1136","volume":"11","author":[{"given":"John A","family":"Johnson","sequence":"first","affiliation":[{"name":"Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kazi T","family":"Haq","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine J","family":"Lutz","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle K","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin A","family":"Paternostro","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie E","family":"Craig","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan W L","family":"Stencel","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lila F","family":"Hawkinson","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maedeh","family":"Khayyat-Kholghi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6976-1313","authenticated-orcid":false,"given":"Larisa G","family":"Tereshchenko","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cardiovascular Division or Knight Cardiovascular Institute, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA"},{"name":"Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,9,3]]},"reference":[{"key":"2025121602153810000_11.9.e048542.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000757"},{"key":"2025121602153810000_11.9.e048542.2","doi-asserted-by":"crossref","unstructured":"Koton S , Sang Y , Schneider ALC . 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