Prevalence, predictors, and prognostic implications of PR interval prolongation in patients with heart failure

• Published in: Clinical research in cardiology Vol. 107; no. 2; pp. 108 - 119
• Main Authors: Nikolaidou, Theodora, Pellicori, Pierpaolo, Zhang, Jufen, Kazmi, Syed, Goode, Kevin M., Cleland, John G., Clark, Andrew L.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2018; Springer Nature B.V
• Subjects: Action Potentials; Age; Aged; Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents - therapeutic use; Beta blockers; Biomarkers - blood; Cardiac arrhythmia; Cardiac Pacing, Artificial; Cardiology; Clinical trials; Defibrillators, Implantable; Digoxin; Electric Countershock - instrumentation; Electrocardiography; England - epidemiology; Female; Fibrillation; Heart Block - diagnosis; Heart Block - epidemiology; Heart Block - physiopathology; Heart Block - therapy; Heart Conduction System - drug effects; Heart Conduction System - physiopathology; Heart diseases; Heart failure; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - physiopathology; Heart Failure - therapy; Heart rate; Heart Rate - drug effects; Humans; Incidence; Male; Medical research; Medicine; Medicine & Public Health; Men; Middle Aged; Natriuretic Peptide, Brain - blood; Original Paper; Patients; Peptide Fragments - blood; Prevalence; Prognosis; Prolongation; Proportional Hazards Models; Prospective Studies; Quartiles; Referral and Consultation; Risk Factors; Stroke Volume; Survival; Ventricular Function, Left; Heart failure; PR interval; First-degree heart block
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-017-1162-6

Aims To determine the prevalence, incidence, predictors, and prognostic implications of PR interval prolongation in patients referred with suspected heart failure. Methods and results Consecutive patients referred with suspected heart failure were prospectively enrolled. After excluding patients with implantable cardiac devices and atrial fibrillation, 1420 patients with heart failure and reduced ejection fraction (HeFREF) [age: median 71 (interquartile range IQR 63–78) years; men: 71%; NT-ProBNP: 1319 (583–3378) ng/L], 1094 with heart failure and normal ejection fraction (HeFNEF) [age: 76 (70–82) years; men: 47%; NT-ProBNP: 547 (321–1171) ng/L], and 1150 without heart failure [age: 68 (60–75) years; men: 51%; NT-ProBNP: 86 (46–140) ng/L] were included. The prevalence of first-degree heart block [heart rate corrected PR interval (PRc) > 200 ms] was higher in patients with heart failure (21% HeFREF, 20% HeFNEF, 9% without heart failure). In patients with HeFREF or HeFNEF, longer baseline PRc was associated with greater age, male sex, and longer QRS duration, and, in those with HeFREF, treatment with amiodarone or digoxin. Patients with heart failure in the longest PRc quartile had worse survival compared to shorter PRc quartiles, but PRc was not independently associated with survival in multivariable analysis. For patients without heart failure, shorter baseline PRc was independently associated with worse survival. Conclusion PRc prolongation is common in patients with HeFREF or HeFNEF and associated with worse survival, although not an independent predictor of outcome. The results of clinical trials investigating the therapeutic potential of shortening the PR interval by pacing are awaited.