Mayra Montalvo1, Prasanna Tadi1, Alexander Merkler2, Gino Gialdini2, Sheryl Martin-Schild3, Digvijaya Navalkele4, Alyana Samai3, Amre Nouh5, Mohammad Hussain5, Steven Goldblatt6, Morgan Hemendinger1, Antony Chu7, Christopher Song7, Hooman Kamel2, Karen L Furie1, Shadi Yaghi8. 1. Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. 2. Departments of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York. 3. Department of Neurology, Tulane University Medical Center, New Orleans, Louisiana. 4. Department of Internal Medicine, Division of Cardiovascular Medicine, Tulane University Medical Center, New Orleans, Louisiana. 5. Department of Neurology, Hartford Hospital, Hartford, Connecticut. 6. Department of Internal Medicine, Division of Cardiovascular Medicine, Hartford Hospital, Hartford, Connecticut. 7. Department of Internal Medicine, Division of Cardiology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. 8. Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: shadiyaghi@yahoo.com.
Abstract
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.
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.
Authors: Muhammad Ali Anees; Muhammad Imtiaz Ahmad; Parag A Chevli; Yabing Li; Elsayed Z Soliman Journal: Ann Noninvasive Electrocardiol Date: 2019-01-19 Impact factor: 1.468