Older Patients with Elevated Pre-sepsis PTFV1 Demonstrate Greater Occurrence of Atrial Fibrillation and Worse In-Hospital Outcomes
Main Article Content
Abstract
Background: Elevated P-wave terminal force in lead V1 (PTFV1) >5000 μV*ms is a predictor of atrial fibrillation and stroke in a general population. The risk for atrial fibrillation and ischemic stroke is high in sepsis but predictors are lacking.
Objectives: Analysis of a prospective, observational cohort study with subjects categorized by PTFV1 (lower and higher than 5000 μV*ms) cutoffs and by age (older and younger than 60 years old).
Methods: Of the 360 consented sepsis patients, 273 had evaluable pre-sepsis electrocardiograms (ECG). PTFV1 was measured by 3 independent and blinded assessors using the Mitutoyo 500-195-30CAL Absolute Digimatic Caliper on the last available ECG before sepsis onset. Patient characteristics and outcomes were compared between lower (PTFV1 < 5,000 μV*ms) and higher PTFV1 (PTFV1 > 5,000 μV*ms), and older and younger patients with elevated pre-sepsis PTFV1.
Results: The median age was 63 years [IQR 53, 71], 44% women. Median of the last ECG prior to sepsis-onset was 1 day [IQR, 0, 9]. 32% of individuals had pre-sepsis PTFV1 > 5,000 μV*ms, and were mostly females. Older patients with PTFV1 > 5,000 μV*ms had greater pre-sepsis left atrial diameter, more in-hospital new-onset atrial fibrillation, greater Charlson Comorbidity Index score, and worse clinical trajectory, compared to younger patients with PTFV1 > 5,000 μV*ms.
Conclusions: Older individuals with elevated pre-sepsis PTFV1 had greater occurrence of AF and worse outcomes during sepsis. Future studies will test pre-sepsis PTFV1 as a predictor of in-hospital and longitudinal outcomes in older sepsis patients at risk of atrial fibrillation, stroke and frailty.
Keywords:
Sepsis, PTFV1, ECG, atrial fibrillation, arrhythmia, stroke
Article Details
How to Cite
MANKOWSKI, Robert T. et al.
Older Patients with Elevated Pre-sepsis PTFV1 Demonstrate Greater Occurrence of Atrial Fibrillation and Worse In-Hospital Outcomes.
Medical Research Archives, [S.l.], v. 13, n. 9, sep. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6970>. Date accessed: 05 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i9.6970.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369:2063. doi: 10.1056/NEJMc1312359
2. Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41:1167-1174. doi: 10.1097/CCM.0b013e3 1827c09f8
3. Torio CM, Moore BJ. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013: Statistical Brief #204. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD); 2006.
4. Gentile LF, Cuenca AG, Efron PA, Ang D, Bihorac A, McKinley BA, Moldawer LL, Moore FA. Persistent inflammation and immunosuppression: a common syndrome and new horizon for surgical intensive care. J Trauma Acute Care Surg. 2012;72:1491-1501. doi: 10.1097/TA.0b013e318256e000
5. Horiguchi H, Loftus TJ, Hawkins RB, Raymond SL, Stortz JA, Hollen MK, Weiss BP, Miller ES, Bihorac A, Larson SD, et al. Innate Immunity in the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome and Its Implications for Therapy. Front Immunol. 2018;9:595. doi: 10.3389/fimmu.2018.00595
6. Mathias B, Delmas AL, Ozrazgat-Baslanti T, Vanzant EL, Szpila BE, Mohr AM, Moore FA, Brakenridge SC, Brumback BA, Moldawer LL, et al. Human Myeloid-derived Suppressor Cells are Associated With Chronic Immune Suppression After Severe Sepsis/Septic Shock. Ann Surg. 2017;265:827-834. doi: 10.1097/SLA.0000000000001783
7. Hollen MK, Stortz JA, Darden D, Dirain ML, Nacionales DC, Hawkins RB, Cox MC, Lopez MC, Rincon JC, Ungaro R, et al. Myeloid-derived suppressor cell function and epigenetic expression evolves over time after surgical sepsis. Crit Care. 2019;23:355. doi: 10.1186/s13054-019-2628-x
8. Stortz JA, Murphy TJ, Raymond SL, Mira JC, Ungaro R, Dirain ML, Nacionales DC, Loftus TJ, Wang Z, Ozrazgat-Baslanti T, et al. Evidence for Persistent Immune Suppression in Patients Who Develop Chronic Critical Illness After Sepsis. Shock. 2018;49:249-258. doi: 10.1097/SHK.0000000000000981
9. Goodwin AJ, Rice DA, Simpson KN, Ford DW. Frequency, cost, and risk factors of readmissions among severe sepsis survivors. Crit Care Med. 2015;43:738-746. doi: 10.1097/CCM.000000000 0000859
10. Stortz JA, Mira JC, Raymond SL, Loftus TJ, Ozrazgat-Baslanti T, Wang Z, Ghita GL, Leeuwenburgh C, Segal MS, Bihorac A, et al. Benchmarking clinical outcomes and the immunocatabolic phenotype of chronic critical illness after sepsis in surgical intensive care unit patients. J Trauma Acute Care Surg. 2018;84:342-349. doi: 10.1097/TA.0000000000001758
11. Brakenridge SC, Efron PA, Cox MC, Stortz JA, Hawkins RB, Ghita G, Gardner A, Mohr AM, Anton SD, Moldawer LL, et al. Current Epidemiology of Surgical Sepsis: Discordance Between Inpatient Mortality and 1-year Outcomes. Ann Surg. 2019;270:502-510. doi: 10.1097/SLA.0000000000003458
12. Proietti M, Romiti GF, Raparelli V, Diemberger I, Boriani G, Dalla Vecchia LA, Bellelli G, Marzetti E, Lip GY, Cesari M. Frailty prevalence and impact on outcomes in patients with atrial fibrillation: A systematic review and meta-analysis of 1,187,000 patients. Ageing Res Rev. 2022;79:101652. doi: 10.1016/j.arr.2022.101652
13. Mankowski RT, Yende S, Angus DC. Long-term impact of sepsis on cardiovascular health. Intensive Care Med. 2019;45:78-81. doi: 10.1007/s00134-018-5173-1
14. Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304:1787-1794. doi: 10.1001/jama.2010.1553
15. Patel N, Bajaj NS, Doshi R, Gupta A, Kalra R, Singh A, Berra L, Arora G, Prabhu SD, Arora P. Cardiovascular Events and Hospital Deaths Among Patients With Severe Sepsis. Am J Cardiol. 2019;123:1406-1413. doi: 10.1016/j.amjcard.2019.01.038
16. Induruwa I, Hennebry E, Hennebry J, Thakur M, Warburton EA, Khadjooi K. Sepsis-driven atrial fibrillation and ischaemic stroke. Is there enough evidence to recommend anticoagulation? Eur J Intern Med. 2022;98:32-36. doi: 10.1016/j.ejim.2021.10. 022
17. Walkey AJ, Hammill BG, Curtis LH, Benjamin EJ. Long-term outcomes following development of new-onset atrial fibrillation during sepsis. Chest. 2014;146:1187-1195. doi: 10.1378/chest.14-0003
18. Walkey AJ, Wiener RS, Ghobrial JM, Curtis LH, Benjamin EJ. Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA. 2011;306:2248-2254. doi: 10.1001/jama.2011.1615
19. Hancock EW, Deal BJ, Mirvis DM, Okin P, Kligfield P, Gettes LS, Bailey JJ, Childers R, Gorgels A, Josephson M, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2009;53:992-1002. doi: 10.1016/j.jacc.2008.12.015
20. He J, Tse G, Korantzopoulos P, Letsas KP, Ali-Hasan-Al-Saegh S, Kamel H, Li G, Lip GYH, Liu T. P-Wave Indices and Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis. Stroke. 2017;48:2066-2072. doi: 10.1161/STROKEAHA.117.017293
21. Kamel H, Bartz TM, Elkind MSV, Okin PM, Thacker EL, Patton KK, Stein PK, deFilippi CR, Gottesman RF, Heckbert SR, et al. Atrial Cardiopathy and the Risk of Ischemic Stroke in the CHS (Cardiovascular Health Study). Stroke. 2018;49:980-986. doi: 10.1161/STROKEAHA.117.020059
22. Jalini S, Rajalingam R, Nisenbaum R, Javier AD, Woo A, Pikula A. Atrial cardiopathy in patients with embolic strokes of unknown source and other stroke etiologies. Neurology. 2019;92:e288-e294. doi: 10.1212/WNL.0000000000006748
23. Kamel H, Longstreth WT, Jr., Tirschwell DL, Kronmal RA, Broderick JP, Palesch YY, Meinzer C, Dillon C, Ewing I, Spilker JA, et al. The AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke randomized trial: Rationale and methods. Int J Stroke. 2019;14:207-214. doi: 10.1177/1747493018799981
24. Loftus TJ, Mira JC, Ozrazgat-Baslanti T, Ghita GL, Wang Z, Stortz JA, Brumback BA, Bihorac A, Segal MS, Anton SD, et al. Sepsis and Critical Illness Research Center investigators: protocols and standard operating procedures for a prospective cohort study of sepsis in critically ill surgical patients. BMJ Open. 2017;7:e015136. doi: 10.1136/bmjopen-2016-015136
25. Campbell-Furtick M, Moore BJ, Overton TL, Laureano Phillips J, Simon KJ, Gandhi RR, Duane TM, Shafi S. Post-trauma mortality increase at age 60: a cutoff for defining elderly? Am J Surg. 2016;212:781-785. doi: 10.1016/j.amjsurg.2015.12.018
26. Hunter MD, Park Moon Y, DeCarli C, Gutierrez J, Wright CB, Di Tullio MR, Sacco RL, Kamel H, Elkind MSV. Electrocardiographic left atrial abnormality and silent vascular brain injury: The Northern Manhattan Study. PLoS One. 2018;13:e0203774. doi: 10.1371/journal.pone.0203774
27. Huo Y, Yoshimura H, Gonzalez-Izquierdo A, Lip GYH, Schmidt F, Providencia R. Risk Factors and Prognosis of New-Onset Atrial Fibrillation in Sepsis: A Nationwide Electronic Health Record Study. JACC Adv. 2025;4:101681. doi: 10.1016/j.jacadv.2025.101681
28. Kwon Y, McHugh S, Ghoreshi K, Lyons GR, Cho Y, Bilchick KC, Mazimba S, Worrall BB, Akoum N, Chen LY, et al. Electrocardiographic left atrial abnormality in patients presenting with ischemic stroke. J Stroke Cerebrovasc Dis. 2020;29:105086. doi: 10.1016/j.jstrokecerebrovasdis.2020.105086
29. Ning Y, Wei M, Song W, Luo G. The Relationship Between Atrial Cardiopathy Biomarkers and Prognosis of Patients With Embolic Stroke of Undetermined Source. Front Cardiovasc Med. 2022;9:829361. doi: 10.3389/fcvm.2022.829361
30. Kamel H, Hunter M, Moon YP, Yaghi S, Cheung K, Di Tullio MR, Okin PM, Sacco RL, Soliman EZ, Elkind MS. Electrocardiographic Left Atrial Abnormality and Risk of Stroke: Northern Manhattan Study. Stroke. 2015;46:3208-3212. doi: 10.1161/STROKEAHA.115.009989
31. Magnani JW, Johnson VM, Sullivan LM, Gorodeski EZ, Schnabel RB, Lubitz SA, Levy D, Ellinor PT, Benjamin EJ. P wave duration and risk of longitudinal atrial fibrillation in persons >/= 60 years old (from the Framingham Heart Study). Am J Cardiol. 2011;107:917-921 e911. doi: 10.1016/j.amjcard.2010.10.075
32. Barter J, Kumar A, Stortz JA, Hollen M, Nacionales D, Efron PA, Moldawer LL, Foster TC. Age and Sex Influence the Hippocampal Response and Recovery Following Sepsis. Mol Neurobiol. 2019;56:8557-8572. doi: 10.1007/s12035-019-01681-y
33. Lopez MC, Efron PA, Ozrazgat-Baslanti T, Zhang J, Cuschieri J, Maier RV, Minei JP, Baker HV, Moore FA, Moldawer LL, et al. Sex-based differences in the genomic response, innate immunity, organ dysfunction, and clinical outcomes after severe blunt traumatic injury and hemorrhagic shock. J Trauma Acute Care Surg. 2016;81:478-485. doi: 10.1097/TA.0000000000001113
34. Lebek S, Wester M, Pec J, Poschenrieder F, Tafelmeier M, Fisser C, Provaznik Z, Schopka S, Debl K, Schmid C, et al. Abnormal P-wave terminal force in lead V1 is a marker for atrial electrical dysfunction but not structural remodelling. ESC Heart Fail. 2021. doi: 10.1002/ehf2.13488
35. Walkey AJ, Quinn EK, Winter MR, McManus DD, Benjamin EJ. Practice Patterns and Outcomes Associated With Use of Anticoagulation Among Patients With Atrial Fibrillation During Sepsis. JAMA Cardiol. 2016;1:682-690. doi: 10.1001/jamacardio.2016.2181
36. Jaroszynski A, Jaroszynska A, Dabrowski W, Zaborowski T, Stepulak A, Ilzecki M, Zubilewicz T. Factors influencing P terminal force in lead V1 of the ECG in hemodialysis patients. Arch Med Sci. 2018;14:257-264. doi: 10.5114/aoms.2017.65926
37. Dunser MW, Hasibeder WR. Sympathetic overstimulation during critical illness: adverse effects of adrenergic stress. J Intensive Care Med. 2009;24:293-316. doi: 10.1177/0885066609340519
38. Schmittinger CA, Torgersen C, Luckner G, Schroder DC, Lorenz I, Dunser MW. Adverse cardiac events during catecholamine vasopressor therapy: a prospective observational study. Intensive Care Med. 2012;38:950-958. doi: 10.1007/s00134-012-2531-2
2. Gaieski DF, Edwards JM, Kallan MJ, Carr BG. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41:1167-1174. doi: 10.1097/CCM.0b013e3 1827c09f8
3. Torio CM, Moore BJ. National Inpatient Hospital Costs: The Most Expensive Conditions by Payer, 2013: Statistical Brief #204. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville (MD); 2006.
4. Gentile LF, Cuenca AG, Efron PA, Ang D, Bihorac A, McKinley BA, Moldawer LL, Moore FA. Persistent inflammation and immunosuppression: a common syndrome and new horizon for surgical intensive care. J Trauma Acute Care Surg. 2012;72:1491-1501. doi: 10.1097/TA.0b013e318256e000
5. Horiguchi H, Loftus TJ, Hawkins RB, Raymond SL, Stortz JA, Hollen MK, Weiss BP, Miller ES, Bihorac A, Larson SD, et al. Innate Immunity in the Persistent Inflammation, Immunosuppression, and Catabolism Syndrome and Its Implications for Therapy. Front Immunol. 2018;9:595. doi: 10.3389/fimmu.2018.00595
6. Mathias B, Delmas AL, Ozrazgat-Baslanti T, Vanzant EL, Szpila BE, Mohr AM, Moore FA, Brakenridge SC, Brumback BA, Moldawer LL, et al. Human Myeloid-derived Suppressor Cells are Associated With Chronic Immune Suppression After Severe Sepsis/Septic Shock. Ann Surg. 2017;265:827-834. doi: 10.1097/SLA.0000000000001783
7. Hollen MK, Stortz JA, Darden D, Dirain ML, Nacionales DC, Hawkins RB, Cox MC, Lopez MC, Rincon JC, Ungaro R, et al. Myeloid-derived suppressor cell function and epigenetic expression evolves over time after surgical sepsis. Crit Care. 2019;23:355. doi: 10.1186/s13054-019-2628-x
8. Stortz JA, Murphy TJ, Raymond SL, Mira JC, Ungaro R, Dirain ML, Nacionales DC, Loftus TJ, Wang Z, Ozrazgat-Baslanti T, et al. Evidence for Persistent Immune Suppression in Patients Who Develop Chronic Critical Illness After Sepsis. Shock. 2018;49:249-258. doi: 10.1097/SHK.0000000000000981
9. Goodwin AJ, Rice DA, Simpson KN, Ford DW. Frequency, cost, and risk factors of readmissions among severe sepsis survivors. Crit Care Med. 2015;43:738-746. doi: 10.1097/CCM.000000000 0000859
10. Stortz JA, Mira JC, Raymond SL, Loftus TJ, Ozrazgat-Baslanti T, Wang Z, Ghita GL, Leeuwenburgh C, Segal MS, Bihorac A, et al. Benchmarking clinical outcomes and the immunocatabolic phenotype of chronic critical illness after sepsis in surgical intensive care unit patients. J Trauma Acute Care Surg. 2018;84:342-349. doi: 10.1097/TA.0000000000001758
11. Brakenridge SC, Efron PA, Cox MC, Stortz JA, Hawkins RB, Ghita G, Gardner A, Mohr AM, Anton SD, Moldawer LL, et al. Current Epidemiology of Surgical Sepsis: Discordance Between Inpatient Mortality and 1-year Outcomes. Ann Surg. 2019;270:502-510. doi: 10.1097/SLA.0000000000003458
12. Proietti M, Romiti GF, Raparelli V, Diemberger I, Boriani G, Dalla Vecchia LA, Bellelli G, Marzetti E, Lip GY, Cesari M. Frailty prevalence and impact on outcomes in patients with atrial fibrillation: A systematic review and meta-analysis of 1,187,000 patients. Ageing Res Rev. 2022;79:101652. doi: 10.1016/j.arr.2022.101652
13. Mankowski RT, Yende S, Angus DC. Long-term impact of sepsis on cardiovascular health. Intensive Care Med. 2019;45:78-81. doi: 10.1007/s00134-018-5173-1
14. Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010;304:1787-1794. doi: 10.1001/jama.2010.1553
15. Patel N, Bajaj NS, Doshi R, Gupta A, Kalra R, Singh A, Berra L, Arora G, Prabhu SD, Arora P. Cardiovascular Events and Hospital Deaths Among Patients With Severe Sepsis. Am J Cardiol. 2019;123:1406-1413. doi: 10.1016/j.amjcard.2019.01.038
16. Induruwa I, Hennebry E, Hennebry J, Thakur M, Warburton EA, Khadjooi K. Sepsis-driven atrial fibrillation and ischaemic stroke. Is there enough evidence to recommend anticoagulation? Eur J Intern Med. 2022;98:32-36. doi: 10.1016/j.ejim.2021.10. 022
17. Walkey AJ, Hammill BG, Curtis LH, Benjamin EJ. Long-term outcomes following development of new-onset atrial fibrillation during sepsis. Chest. 2014;146:1187-1195. doi: 10.1378/chest.14-0003
18. Walkey AJ, Wiener RS, Ghobrial JM, Curtis LH, Benjamin EJ. Incident stroke and mortality associated with new-onset atrial fibrillation in patients hospitalized with severe sepsis. JAMA. 2011;306:2248-2254. doi: 10.1001/jama.2011.1615
19. Hancock EW, Deal BJ, Mirvis DM, Okin P, Kligfield P, Gettes LS, Bailey JJ, Childers R, Gorgels A, Josephson M, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2009;53:992-1002. doi: 10.1016/j.jacc.2008.12.015
20. He J, Tse G, Korantzopoulos P, Letsas KP, Ali-Hasan-Al-Saegh S, Kamel H, Li G, Lip GYH, Liu T. P-Wave Indices and Risk of Ischemic Stroke: A Systematic Review and Meta-Analysis. Stroke. 2017;48:2066-2072. doi: 10.1161/STROKEAHA.117.017293
21. Kamel H, Bartz TM, Elkind MSV, Okin PM, Thacker EL, Patton KK, Stein PK, deFilippi CR, Gottesman RF, Heckbert SR, et al. Atrial Cardiopathy and the Risk of Ischemic Stroke in the CHS (Cardiovascular Health Study). Stroke. 2018;49:980-986. doi: 10.1161/STROKEAHA.117.020059
22. Jalini S, Rajalingam R, Nisenbaum R, Javier AD, Woo A, Pikula A. Atrial cardiopathy in patients with embolic strokes of unknown source and other stroke etiologies. Neurology. 2019;92:e288-e294. doi: 10.1212/WNL.0000000000006748
23. Kamel H, Longstreth WT, Jr., Tirschwell DL, Kronmal RA, Broderick JP, Palesch YY, Meinzer C, Dillon C, Ewing I, Spilker JA, et al. The AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke randomized trial: Rationale and methods. Int J Stroke. 2019;14:207-214. doi: 10.1177/1747493018799981
24. Loftus TJ, Mira JC, Ozrazgat-Baslanti T, Ghita GL, Wang Z, Stortz JA, Brumback BA, Bihorac A, Segal MS, Anton SD, et al. Sepsis and Critical Illness Research Center investigators: protocols and standard operating procedures for a prospective cohort study of sepsis in critically ill surgical patients. BMJ Open. 2017;7:e015136. doi: 10.1136/bmjopen-2016-015136
25. Campbell-Furtick M, Moore BJ, Overton TL, Laureano Phillips J, Simon KJ, Gandhi RR, Duane TM, Shafi S. Post-trauma mortality increase at age 60: a cutoff for defining elderly? Am J Surg. 2016;212:781-785. doi: 10.1016/j.amjsurg.2015.12.018
26. Hunter MD, Park Moon Y, DeCarli C, Gutierrez J, Wright CB, Di Tullio MR, Sacco RL, Kamel H, Elkind MSV. Electrocardiographic left atrial abnormality and silent vascular brain injury: The Northern Manhattan Study. PLoS One. 2018;13:e0203774. doi: 10.1371/journal.pone.0203774
27. Huo Y, Yoshimura H, Gonzalez-Izquierdo A, Lip GYH, Schmidt F, Providencia R. Risk Factors and Prognosis of New-Onset Atrial Fibrillation in Sepsis: A Nationwide Electronic Health Record Study. JACC Adv. 2025;4:101681. doi: 10.1016/j.jacadv.2025.101681
28. Kwon Y, McHugh S, Ghoreshi K, Lyons GR, Cho Y, Bilchick KC, Mazimba S, Worrall BB, Akoum N, Chen LY, et al. Electrocardiographic left atrial abnormality in patients presenting with ischemic stroke. J Stroke Cerebrovasc Dis. 2020;29:105086. doi: 10.1016/j.jstrokecerebrovasdis.2020.105086
29. Ning Y, Wei M, Song W, Luo G. The Relationship Between Atrial Cardiopathy Biomarkers and Prognosis of Patients With Embolic Stroke of Undetermined Source. Front Cardiovasc Med. 2022;9:829361. doi: 10.3389/fcvm.2022.829361
30. Kamel H, Hunter M, Moon YP, Yaghi S, Cheung K, Di Tullio MR, Okin PM, Sacco RL, Soliman EZ, Elkind MS. Electrocardiographic Left Atrial Abnormality and Risk of Stroke: Northern Manhattan Study. Stroke. 2015;46:3208-3212. doi: 10.1161/STROKEAHA.115.009989
31. Magnani JW, Johnson VM, Sullivan LM, Gorodeski EZ, Schnabel RB, Lubitz SA, Levy D, Ellinor PT, Benjamin EJ. P wave duration and risk of longitudinal atrial fibrillation in persons >/= 60 years old (from the Framingham Heart Study). Am J Cardiol. 2011;107:917-921 e911. doi: 10.1016/j.amjcard.2010.10.075
32. Barter J, Kumar A, Stortz JA, Hollen M, Nacionales D, Efron PA, Moldawer LL, Foster TC. Age and Sex Influence the Hippocampal Response and Recovery Following Sepsis. Mol Neurobiol. 2019;56:8557-8572. doi: 10.1007/s12035-019-01681-y
33. Lopez MC, Efron PA, Ozrazgat-Baslanti T, Zhang J, Cuschieri J, Maier RV, Minei JP, Baker HV, Moore FA, Moldawer LL, et al. Sex-based differences in the genomic response, innate immunity, organ dysfunction, and clinical outcomes after severe blunt traumatic injury and hemorrhagic shock. J Trauma Acute Care Surg. 2016;81:478-485. doi: 10.1097/TA.0000000000001113
34. Lebek S, Wester M, Pec J, Poschenrieder F, Tafelmeier M, Fisser C, Provaznik Z, Schopka S, Debl K, Schmid C, et al. Abnormal P-wave terminal force in lead V1 is a marker for atrial electrical dysfunction but not structural remodelling. ESC Heart Fail. 2021. doi: 10.1002/ehf2.13488
35. Walkey AJ, Quinn EK, Winter MR, McManus DD, Benjamin EJ. Practice Patterns and Outcomes Associated With Use of Anticoagulation Among Patients With Atrial Fibrillation During Sepsis. JAMA Cardiol. 2016;1:682-690. doi: 10.1001/jamacardio.2016.2181
36. Jaroszynski A, Jaroszynska A, Dabrowski W, Zaborowski T, Stepulak A, Ilzecki M, Zubilewicz T. Factors influencing P terminal force in lead V1 of the ECG in hemodialysis patients. Arch Med Sci. 2018;14:257-264. doi: 10.5114/aoms.2017.65926
37. Dunser MW, Hasibeder WR. Sympathetic overstimulation during critical illness: adverse effects of adrenergic stress. J Intensive Care Med. 2009;24:293-316. doi: 10.1177/0885066609340519
38. Schmittinger CA, Torgersen C, Luckner G, Schroder DC, Lorenz I, Dunser MW. Adverse cardiac events during catecholamine vasopressor therapy: a prospective observational study. Intensive Care Med. 2012;38:950-958. doi: 10.1007/s00134-012-2531-2