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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.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|July 2, 2017
PubMed
Summary

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.

Keywords:
Cryptogenic strokePR interval prolongationatrial cardiopathyatrial fibrillationischemic stroke

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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.