PR Interval Prolongation and Cryptogenic Stroke: A Multicenter Retrospective Study

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.

Abstract WMP62: PR Interval Prolongation and Cryptogenic Stroke: A Multicenter Retrospective Study

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 useful biomarker of atrial cardiopathy. We aim to compare the prevalence of PR interval prolongation in patients with cryptogenic stroke (CS) when compared to known non-cryptogenic non-cardioembolic stroke (NCNCS) subtypes.

Methods: We retrospectively analyzed prospective ischemic stroke databases and included consecutive patients between December 1 st , 2013 and August 31 st , 2015 in three comprehensive stroke centers (Rhode Island Hospital, Hartford Hospital, and Tulane University Medical Center). Consecutive patients 18 years or older with a discharge diagnosis of ischemic non-cardioembolic stroke were included. The main outcome was ischemic stroke subtype (CS vs. NCNCS). We compared PR intervals as a continuous and categorical variable (< 200 ms; ≥ 200 ms) and other clinical and demographic factors between the two groups and used multivariate regression analyses including age and other factors deemed significant on univariate 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). The PR interval was longer in patients with CS vs NCNCS (175.4 ± 35.2 ms vs. 166.5 ± 27.7 p = 0.005). After adjusting for factors that were found to be significant in univariate analyses, a prolonged PR interval was independently associated with CS (Odds Ratio: 1.70; 95% CI 1.08-2.70; p=0.022). The association was more pronounced when excluding patients on atrio-ventricular nodal blocking agents (OR=2.64, 95% CI 1.44-4.83, p=0.002).

Conclusions: A prolonged PR interval is associated with CS and may be a biomarker of atrial cardiopathy in patients with cryptogenic stroke. This association needs to be confirmed in prospective neuro-epidemiological cohorts.

Pathogen transmission in child care settings studied by using a cauliflower virus DNA as a surrogate marker

Two regions of cauliflower mosaic virus DNA were designed as markers to study pathogen transmission in a child care home (CCH) and child care center (CCC) and in homes of CCC children. The DNA markers were stable for 1 month in the environment. The DNA markers were introduced into the environment through sensitized objects, and spread in the environment was traced by detection of the markers with polymerase chain reaction. The DNA markers spread rapidly in both the CCH and CCC after introduction and spread more rapidly in the toddler room than in the infant room of the CCC. Hand touching of contaminated areas was the major factor leading to spread of the markers. Hand washing and surface wiping decreased spread of the markers. The markers spread minimally from room to room in the CCC but were detected in the children's homes after introduction of markers in the CCC.

A strident public impatience drives true change. Interview by Carolyn Dunbar

Sunquest's president and chief executive officer, Sidney Goldblatt, M.D., says the inefficient way information is shared in healthcare is "stupid" and wouldn't be tolerated in other industries. Until the public becomes impatient and strident about flagrant waste and begins to demand most cost-effective methods in healthcare, true change will take a lot longer.