Electrocardiographic PR Interval Duration and Cardiovascular Risk: Results From the Copenhagen ECG Study

Peter Vibe Rasmussen; Jonas Bille Nielsen; Morten Wagner Skov; Adrian Pietersen; Claus Graff; Bent Lind; Johannes Jan Struijk; Morten Salling Olesen; Stig Haunsø; Lars Køber; Jesper Hastrup Svendsen; Anders Gaarsdal Holst

doi:10.1016/j.cjca.2017.02.015

Electrocardiographic PR Interval Duration and Cardiovascular Risk: Results From the Copenhagen ECG Study

Peter Vibe Rasmussen, Jonas Bille Nielsen, Morten Wagner Skov, Adrian Pietersen, Claus Graff, Bent Lind, Johannes Jan Struijk, Morten Salling Olesen, Stig Haunsø, Lars Køber, Jesper Hastrup Svendsen, Anders Gaarsdal Holst

14 Citations (Scopus)

Abstract

Background Because of ambiguous reports in the literature, we aimed to investigate the association between PR interval and the risk of all-cause and cardiovascular death, heart failure, and pacemaker implantation, allowing for a nonlinear relationship. Methods We included 293,111 individuals, corresponding to one-third of the population in the greater region of Copenhagen. These individuals had a digital electrocardiogram recorded in a general practitioner's core facility from 2001-2011. Data on drug use, comorbidities, and outcomes were collected from Danish registries. We divided the population into 7 groups based on the population PR interval distribution. Cox models were used, with reference to a PR interval between 152 and 161 ms (40th to < 60th percentile). Results During follow-up, we identified 34,783 deaths from all causes, 9867 cardiovascular deaths, 9526 cases of incident heart failure, and 1805 pacemaker implantations. A short PR interval (< 125 ms; hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.08-1.41; P = 0.001) as well as a long PR interval (> 200 ms; HR, 1.23; 95% CI, 1.14-1.32; P < 0.001) was associated with an increased risk of cardiovascular death after multivariable adjustment. A long PR interval conferred an increased risk of heart failure (> 200 ms; HR, 1.31; 95% CI, 1.22-1.42; P < 0.001). An increasing PR interval conferred an increased risk of pacemaker implantation, in a dose-response manner, with the highest risk associated with a PR interval > 200 ms (HR, 3.49; 95% CI, 2.96-4.11; P < 0.001). Conclusions PR interval was significantly associated with the risk of the adverse outcomes investigated. The nonlinear relationships, in combination with relatively weak associations, could contribute to previously reported conflicting results on the subject.

Original language	English
Journal	Canadian Journal of Cardiology
Volume	33
Issue number	5
Pages (from-to)	674-681
Number of pages	8
ISSN	0828-282X
DOIs	https://doi.org/10.1016/j.cjca.2017.02.015
Publication status	Published - May 2017

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Rasmussen, P. V., Nielsen, J. B., Skov, M. W., Pietersen, A., Graff, C., Lind, B., Struijk, J. J., Olesen, M. S., Haunsø, S., Køber, L., Svendsen, J. H., & Holst, A. G. (2017). Electrocardiographic PR Interval Duration and Cardiovascular Risk: Results From the Copenhagen ECG Study. Canadian Journal of Cardiology, 33(5), 674-681. https://doi.org/10.1016/j.cjca.2017.02.015

@article{9eec0cbf33fa45c5879831b838ca2ef0,

title = "Electrocardiographic PR Interval Duration and Cardiovascular Risk: Results From the Copenhagen ECG Study",

abstract = "Background Because of ambiguous reports in the literature, we aimed to investigate the association between PR interval and the risk of all-cause and cardiovascular death, heart failure, and pacemaker implantation, allowing for a nonlinear relationship. Methods We included 293,111 individuals, corresponding to one-third of the population in the greater region of Copenhagen. These individuals had a digital electrocardiogram recorded in a general practitioner's core facility from 2001-2011. Data on drug use, comorbidities, and outcomes were collected from Danish registries. We divided the population into 7 groups based on the population PR interval distribution. Cox models were used, with reference to a PR interval between 152 and 161 ms (40th to < 60th percentile). Results During follow-up, we identified 34,783 deaths from all causes, 9867 cardiovascular deaths, 9526 cases of incident heart failure, and 1805 pacemaker implantations. A short PR interval (< 125 ms; hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.08-1.41; P = 0.001) as well as a long PR interval (> 200 ms; HR, 1.23; 95% CI, 1.14-1.32; P < 0.001) was associated with an increased risk of cardiovascular death after multivariable adjustment. A long PR interval conferred an increased risk of heart failure (> 200 ms; HR, 1.31; 95% CI, 1.22-1.42; P < 0.001). An increasing PR interval conferred an increased risk of pacemaker implantation, in a dose-response manner, with the highest risk associated with a PR interval > 200 ms (HR, 3.49; 95% CI, 2.96-4.11; P < 0.001). Conclusions PR interval was significantly associated with the risk of the adverse outcomes investigated. The nonlinear relationships, in combination with relatively weak associations, could contribute to previously reported conflicting results on the subject.",

author = "Rasmussen, {Peter Vibe} and Nielsen, {Jonas Bille} and Skov, {Morten Wagner} and Adrian Pietersen and Claus Graff and Bent Lind and Struijk, {Johannes Jan} and Olesen, {Morten Salling} and Stig Hauns{\o} and Lars K{\o}ber and Svendsen, {Jesper Hastrup} and Holst, {Anders Gaarsdal}",

year = "2017",

month = may,

doi = "10.1016/j.cjca.2017.02.015",

language = "English",

volume = "33",

pages = "674--681",

journal = "Canadian Journal of Cardiology",

issn = "0828-282X",

publisher = "Elsevier",

number = "5",

}

TY - JOUR

T1 - Electrocardiographic PR Interval Duration and Cardiovascular Risk

T2 - Results From the Copenhagen ECG Study

AU - Rasmussen, Peter Vibe

AU - Nielsen, Jonas Bille

AU - Skov, Morten Wagner

AU - Pietersen, Adrian

AU - Graff, Claus

AU - Lind, Bent

AU - Struijk, Johannes Jan

AU - Olesen, Morten Salling

AU - Haunsø, Stig

AU - Køber, Lars

AU - Svendsen, Jesper Hastrup

AU - Holst, Anders Gaarsdal

PY - 2017/5

Y1 - 2017/5

N2 - Background Because of ambiguous reports in the literature, we aimed to investigate the association between PR interval and the risk of all-cause and cardiovascular death, heart failure, and pacemaker implantation, allowing for a nonlinear relationship. Methods We included 293,111 individuals, corresponding to one-third of the population in the greater region of Copenhagen. These individuals had a digital electrocardiogram recorded in a general practitioner's core facility from 2001-2011. Data on drug use, comorbidities, and outcomes were collected from Danish registries. We divided the population into 7 groups based on the population PR interval distribution. Cox models were used, with reference to a PR interval between 152 and 161 ms (40th to < 60th percentile). Results During follow-up, we identified 34,783 deaths from all causes, 9867 cardiovascular deaths, 9526 cases of incident heart failure, and 1805 pacemaker implantations. A short PR interval (< 125 ms; hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.08-1.41; P = 0.001) as well as a long PR interval (> 200 ms; HR, 1.23; 95% CI, 1.14-1.32; P < 0.001) was associated with an increased risk of cardiovascular death after multivariable adjustment. A long PR interval conferred an increased risk of heart failure (> 200 ms; HR, 1.31; 95% CI, 1.22-1.42; P < 0.001). An increasing PR interval conferred an increased risk of pacemaker implantation, in a dose-response manner, with the highest risk associated with a PR interval > 200 ms (HR, 3.49; 95% CI, 2.96-4.11; P < 0.001). Conclusions PR interval was significantly associated with the risk of the adverse outcomes investigated. The nonlinear relationships, in combination with relatively weak associations, could contribute to previously reported conflicting results on the subject.

AB - Background Because of ambiguous reports in the literature, we aimed to investigate the association between PR interval and the risk of all-cause and cardiovascular death, heart failure, and pacemaker implantation, allowing for a nonlinear relationship. Methods We included 293,111 individuals, corresponding to one-third of the population in the greater region of Copenhagen. These individuals had a digital electrocardiogram recorded in a general practitioner's core facility from 2001-2011. Data on drug use, comorbidities, and outcomes were collected from Danish registries. We divided the population into 7 groups based on the population PR interval distribution. Cox models were used, with reference to a PR interval between 152 and 161 ms (40th to < 60th percentile). Results During follow-up, we identified 34,783 deaths from all causes, 9867 cardiovascular deaths, 9526 cases of incident heart failure, and 1805 pacemaker implantations. A short PR interval (< 125 ms; hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.08-1.41; P = 0.001) as well as a long PR interval (> 200 ms; HR, 1.23; 95% CI, 1.14-1.32; P < 0.001) was associated with an increased risk of cardiovascular death after multivariable adjustment. A long PR interval conferred an increased risk of heart failure (> 200 ms; HR, 1.31; 95% CI, 1.22-1.42; P < 0.001). An increasing PR interval conferred an increased risk of pacemaker implantation, in a dose-response manner, with the highest risk associated with a PR interval > 200 ms (HR, 3.49; 95% CI, 2.96-4.11; P < 0.001). Conclusions PR interval was significantly associated with the risk of the adverse outcomes investigated. The nonlinear relationships, in combination with relatively weak associations, could contribute to previously reported conflicting results on the subject.

U2 - 10.1016/j.cjca.2017.02.015

DO - 10.1016/j.cjca.2017.02.015

M3 - Journal article

C2 - 28449838

AN - SCOPUS:85018672839

SN - 0828-282X

VL - 33

SP - 674

EP - 681

JO - Canadian Journal of Cardiology

JF - Canadian Journal of Cardiology

IS - 5

ER -

Electrocardiographic PR Interval Duration and Cardiovascular Risk: Results From the Copenhagen ECG Study

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