Value of frontal QRS axis for risk stratification of individuals with prolonged PR interval

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Noninvasive Electrocardiology Pub Date : 2023-05-27 DOI:10.1111/anec.13066

Xiaodi Cao MD, Zhe Wang MD, Zhang Fang MD, Chuanchuan Yu MD, Linsheng Shi MD and PhD

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Abstract

Background

There is ongoing controversy regarding the prognostic value of PR prolongation among individuals free of cardiovascular diseases. It is necessary to risk-stratify this population according to other electrocardiographic parameters.

Methods

This study is based on the Third National Health and Nutrition Examination Survey. Cox proportional hazard models were constructed and Kaplan–Meier method was used.

Results

A total of 6188 participants (58.1 ± 13.1 years; 55% women) were included. The median frontal QRS axis of the entire study population was 37° (IQR: 11–60°). PR prolongation was present in 7.6% of the participants, of whom 61.2% had QRS axis ≤37°. In a multivariable-adjusted model, mortality risk was highest in the group with concomitant prolonged PR interval and QRS axis ≤37° (hazard ratio [HR]: 1.20; 95% confidence interval [CI]: 1.04–1.39). In models with similar adjustment where population were reclassified depending on PR prolongation and QRS axis, prolonged PR interval and QRS axis ≤37° was still associated with increased risk of mortality (HR: 1.18; 95% CI: 1.03–1.36) compared with normal PR interval.

Conclusions

QRS axis is an important factor for risk stratification in population with PR prolongation. The extent to which this population with PR prolongation and QRS axis ≤37° is at higher risk of death compared with the population without PR prolongation.

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正面QRS轴对PR间期延长个体风险分层的价值

关于无心血管疾病个体PR延长的预后价值一直存在争议。有必要根据其他心电图参数对这一人群进行风险分层。方法本研究以第三次全国健康与营养调查为基础。建立Cox比例风险模型，采用Kaplan-Meier法。结果6188名受试者(58.1±13.1岁;(55%为女性)。整个研究人群的额位QRS轴中位数为37°(IQR: 11-60°)。7.6%的受试者PR延长，其中61.2%的受试者QRS轴≤37°。在多变量调整模型中，PR间期延长且QRS轴≤37°组的死亡风险最高(风险比[HR]: 1.20;95%置信区间[CI]: 1.04-1.39)。在类似调整的模型中，根据PR间隔延长和QRS轴对人群进行重新分类，PR间隔延长和QRS轴≤37°仍与死亡风险增加相关(HR: 1.18;95% CI: 1.03-1.36)。结论QRS轴是PR延长人群危险分层的重要因素。PR延长且QRS轴≤37°的人群死亡风险高于PR未延长人群。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Noninvasive Electrocardiology 医学-心血管系统

CiteScore

3.40

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： The ANNALS OF NONINVASIVE ELECTROCARDIOLOGY (A.N.E) is an online only journal that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. ANE is the first journal in an evolving subspecialty that incorporates ongoing advances in the clinical application and technology of traditional and new ECG-based techniques in the diagnosis and treatment of cardiac patients. The publication includes topics related to 12-lead, exercise and high-resolution electrocardiography, arrhythmias, ischemia, repolarization phenomena, heart rate variability, circadian rhythms, bioengineering technology, signal-averaged ECGs, T-wave alternans and automatic external defibrillation. ANE publishes peer-reviewed articles of interest to clinicians and researchers in the field of noninvasive electrocardiology. Original research, clinical studies, state-of-the-art reviews, case reports, technical notes, and letters to the editors will be published to meet future demands in this field.