Key result
A PR interval of 160 ms or greater was significantly associated with a higher risk of advanced white matter hyperintensities (OR 2.1) compared to shorter PR intervals.
Why the study?
PR interval prolongation reflects atrial cardiomyopathy linked to AF, a risk factor for cerebrovascular outcomes, but its relationship with white matter hyperintensities was unknown.
Is PR interval duration associated with the presence of advanced white matter hyperintensities in a general adult population?
Cross-Sectional (n=2,464)
No
Is PR interval duration associated with the presence of advanced white matter hyperintensities in a general adult population?
Odds Ratio: 2.1 (95% CI 1.6–2.7)
p-value: p=<0.001
Prolonged PR interval is independently associated with advanced cerebral white matter hyperintensities, suggesting a potential link between early atrial cardiomyopathy and cerebral small vessel disease.
BACKGROUND: PR interval prolongation is a preliminary stage of atrial cardiomyopathy which is considered as an intermediate phenotype for atrial fibrillation (AF). AF is a known risk factor for cerebrovascular adverse outcomes including stroke. Cerebral ischemia is one cause of white matter hyperintensities (WMHs), and cognitive dysfunction. AIM: To analyze the relationship between PR interval and WMHs. MATERIALS AND METHODS: We performed a cross-sectional analysis with individuals from the LIFE-Adult-Study (a population-based cohort study of randomly selected individuals from Leipzig, Germany) with available brain MRI and ECG. The Fazekas stages were used to quantify WMHs (0 = none; 1 = punctate foci; 2 = beginning confluence; 3 = large confluent areas). Stages 2-3 were defined as advanced WMHs. The PR interval was measured from resting 12-lead ECG. PR duration >200ms was defined as PR interval prolongation. We used a binary logistic regression for statistical analysis. We examined the relationship between MRI and ECG measures and adjusted them for clinical risk factors. RESULTS: We included 2464 individuals (age 59±15 years, 47% women) into analyses. The median PR interval was 160ms (interquartile range 143-179), and 319 (13%) individuals with advanced WMHs, were significantly older, had more cardiovascular comorbidities and risk factors compared to individuals without WMHs (all p<0.005). On univariable analysis, PR interval duration (OR 1.01, 95%CI 1.01-1.02, p≤0.001) and PR interval ≥160 ms (OR 2.1, 95%CI 1.6-2.7, p≤0.001) were associated with advanced WMHs. In multivariable analysis, while PR interval duration was not associated with WMHs in the whole cohort, individuals with PR ≥160ms had higher risk for WMHs. CONCLUSION: PR interval duration is associated with advanced WMHs beside advanced age, hypertension, and history of stroke. Further research is needed to determine whether changes in PR interval indices are clinically relevant for changes in WMHs.
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Kornej et al. (2022) conducted a cross-sectional in White matter hyperintensities (n=2,464). PR interval ≥160 ms vs. PR interval <160 ms was evaluated on Advanced white matter hyperintensities (Fazekas stages 2-3) (OR 2.1, 95% CI 1.6-2.7, p=<0.001). A PR interval of 160 ms or greater was significantly associated with a higher risk of advanced white matter hyperintensities (OR 2.1) compared to shorter PR intervals.
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