PR interval prolongation in coronary patients or risk equivalent: excess risk of ischemic stroke and vascular pathophysiological insights

BMC Cardiovascular Disorders

Research Article

Sheung-Wai Li¹  Jo Jo Hai²  Kai-Hang Yiu²  Chu-Pak Lau²  Yap-Hang Chan²  Chung-Wah Siu³  Hung-Fat Tse³  Kui-Kai Lau⁴ 

[1] Department of Medicine, Tung Wah Hospital, Hong Kong, SAR, China;Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Rm 1928, Block K, Hong Kong, China;Division of Cardiology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Rm 1928, Block K, Hong Kong, China;Research Center of Heart, Brain, Hormone and Healthy Ageing, University of Hong Kong, Hong Kong, China;Division of Neurology, University of Hong Kong, Hong Kong, China;

关键词: PR interval prolongation;    Cardiovascular death;    Myocardial infarction;    Ischemic stroke;    Carotid intima-media thickness;    Vascular function;    Pathophysiological mechanism;   

DOI  :  10.1186/s12872-017-0667-2

 received in 2017-04-27, accepted in 2017-08-17,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundWhether PR prolongation independently predicts new-onset ischemic events of myocardial infarction and stroke was unclear. Underlying pathophysiological mechanisms of PR prolongation leading to adverse cardiovascular events were poorly understood. We investigated the role of PR prolongation in pathophysiologically-related adverse cardiovascular events and underlying mechanisms.MethodsWe prospectively investigated 597 high-risk cardiovascular outpatients (mean age 66 ± 11 yrs.; male 67%; coronary disease 55%, stroke 22%, diabetes 52%) for new-onset ischemic stroke, myocardial infarction (MI), congestive heart failure (CHF), and cardiovascular death. Vascular phenotype was determined by carotid intima-media thickness (IMT).ResultsPR prolongation >200 ms was present in 79 patients (13%) at baseline. PR prolongation >200 ms was associated with significantly higher mean carotid IMT (1.05 ± 0.37 mm vs 0.94 ± 0.28 mm, P = 0.010). After mean study period of 63 ± 11 months, increased PR interval significantly predicted new-onset ischemic stroke (P = 0.006), CHF (P = 0.040), cardiovascular death (P < 0.001), and combined cardiovascular endpoints (P < 0.001) at cut-off >200 ms. Using multivariable Cox regression, PR prolongation >200 ms independently predicted new-onset ischemic stroke (HR 8.6, 95% CI: 1.9–37.8, P = 0.005), cardiovascular death (HR 14.1, 95% CI: 3.8–51.4, P < 0.001) and combined cardiovascular endpoints (HR 2.4, 95% CI: 1.30–4.43, P = 0.005). PR interval predicts new-onset MI at the exploratory cut-off >162 ms (C-statistic 0.70, P = 0.001; HR: 8.0, 95% CI: 1.65–38.85, P = 0.010).ConclusionsPR prolongation strongly predicts new-onset ischemic stroke, MI, cardiovascular death, and combined cardiovascular endpoint including CHF in coronary patients or risk equivalent. Adverse vascular function may implicate an intermediate pathophysiological phenotype or mediating mechanism.

【 授权许可】

CC BY   
© The Author(s). 2017