PR Interval Prolongation and Cryptogenic Stroke: A Multicenter Retrospective Study
Mayra Montalvo1, Prasanna Tadi1, Alexander Merkler2
1Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Insights
Prolonged PR interval (≥200 milliseconds) is linked to cryptogenic stroke (CS), suggesting it may indicate atrial cardiopathy. This finding holds significance even without atrial fibrillation, warranting further investigation.
Area of Science:
- Cardiology
- Neurology
- Stroke Medicine
Background:
- Atrial dysfunction, termed atrial cardiopathy, is a potential mechanism underlying cryptogenic stroke (CS).
- A prolonged PR interval on electrocardiogram (ECG) may signify impaired atrial conduction, serving as a potential biomarker for atrial cardiopathy.
Purpose of the Study:
- To compare the prevalence of PR interval prolongation in patients diagnosed with cryptogenic stroke (CS) versus non-cryptogenic non-cardioembolic stroke (NCNCS).
Main Methods:
- Utilized prospective ischemic stroke databases from three comprehensive stroke centers.
- Included adult patients (≥18 years) with ischemic non-cardioembolic stroke diagnoses between December 2013 and August 2015.
- Compared PR intervals (continuous and categorical: <200 ms; ≥200 ms) and clinical factors between CS and NCNCS groups, employing multivariate regression analysis.
Main Results:
- Identified 644 patients (224 CS, 420 NCNCS).
- A PR interval ≥200 ms was more prevalent in CS patients (23.2%) compared to NCNCS patients (13.8%; P=.009).
- After adjustment, a PR interval ≥200 ms remained independently associated with CS (OR 1.70; 95% CI 1.08-2.70), with a stronger association observed when excluding patients on AV nodal blocking agents (OR 2.64; 95% CI 1.44-4.83).
Conclusions:
- A prolonged PR interval (≥200 ms) is associated with cryptogenic stroke.
- This finding suggests that a prolonged PR interval may serve as a biomarker for atrial cardiopathy, particularly in the absence of atrial fibrillation.
- Further prospective studies are recommended to validate this association.
Background:
Atrial dysfunction or "cardiopathy" has been recently proposed as a mechanism in cryptogenic stroke. A prolonged PR interval may reflect impaired atrial conduction and thus may be a biomarker of atrial cardiopathy. We aim to compare the prevalence of PR interval prolongation in patients with cryptogenic stroke (CS) when compared with known non-cryptogenic non-cardioembolic stroke (NCNCS) subtypes.
Methods:
We used prospective ischemic stroke databases of 3 comprehensive stroke centers to identify patients 18 years or older with a discharge diagnosis of ischemic non-cardioembolic stroke between December 1, 2013 and August 31, 2015. The main outcome was ischemic stroke subtype (CS versus NCNCS). We compared PR intervals as a continuous and categorical variable (<200 milliseconds; ≥200 milliseconds) and other clinical and demographic factors between the 2 groups and used multivariate regression analyses to determine the association between PR interval prolongation and CS.
Results:
We identified 644 patients with ischemic non-cardioembolic stroke (224 CS and 420 NCNCS). Patients with CS were more likely to have a PR of 200 milliseconds or greater when compared with those with NCNCS (23.2% versus 13.8%, P = .009). After adjusting for factors that were significant in univariate analyses, a PR of 200 milliseconds or greater was independently associated with CS (odds ratio [OR] 1.70, 95% CI 1.08-2.70). The association was more pronounced when excluding patients on atrioventricular nodal blocking agents (OR 2.64, 95% CI 1.44-4.83).
Conclusions:
A PR of 200 milliseconds or greater is associated with CS and may be a biomarker of atrial cardiopathy in the absence of atrial fibrillation. Prospective studies are needed to confirm this association.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...