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Multicenter Study
. 2015 Sep;104(9):743-50.
doi: 10.1007/s00392-015-0838-z. Epub 2015 Mar 10.

The association of the QT interval with atrial fibrillation and stroke: the Multi-Ethnic Study of Atherosclerosis

Wesley T O'Neal  1 , Jimmy T Efird, Hooman Kamel, Saman Nazarian, Alvaro Alonso, Susan R Heckbert, W T Longstreth Jr, Elsayed Z Soliman
Affiliations
Multicenter Study

The association of the QT interval with atrial fibrillation and stroke: the Multi-Ethnic Study of Atherosclerosis

Wesley T O'Neal et al. Clin Res Cardiol. 2015 Sep.

Abstract

Background: Prolongation of the QT interval is associated with an increased risk of atrial fibrillation (AF) and stroke.

Objectives: The purpose of this analysis was to determine if AF explains the association between prolonged QT and stroke.

Methods: A total of 6305 participants (mean age 62 ± 10 years; 54% women; 38% whites; 27% blacks; 23% Hispanics; 12% Chinese-Americans) from the Multi-Ethnic Study of Atherosclerosis (MESA) were included in this analysis. A linear scale was used to compute heart rate-adjusted QT (QT(a)). Prolonged QT(a) was defined as ≥ 460 ms in women and ≥ 450 ms in men. Incident AF cases were identified using hospital discharge records and Medicare claims data. Vascular neurologists adjudicated stroke events by medical record review. Cox regression was used to examine the association between prolonged QT(a) and stroke with and without AF.

Results: A total of 216 (3.4%) of study participants had prolonged QT(a). Over a median follow-up of 8.5 years, 280 (4.4%) participants developed AF and 128 (2.0%) participants developed stroke. In a multivariable Cox regression analysis adjusted for socio-demographics, cardiovascular risk factors, and potential confounders, prolonged QT(a) was associated with an increased risk of AF (HR = 1.7, 95% CI 1.1, 2.6) and stroke (HR = 2.3, 95% CI 1.3, 4.1). When AF was included as a time-dependent covariate, the association between prolonged QT(a) and stroke was not substantively altered (HR = 2.4, 95% CI 1.3, 4.3).

Conclusion: The increased risk of stroke in those with prolonged QT potentially is not explained by documented AF. Further research is needed to determine if subclinical AF explains the association between the QT interval and stroke.

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Figures

Figure 1
Figure 1
Unadjusted Cumulative Incidence of AF (A) and Stroke (B) by Prolonged QTa* The differences between unadjusted incidence curves for AF (log-rank p<0.0001) and stroke (log-rank p<0.0001) by prolonged QTa were statistically significant. *QTa was computed with the following formula: QT + 2.38*(heart rate-60). AF=atrial fibrillation.
Figure 2
Figure 2
Association of QTa with AF (A) and Stroke (B).*† *Each hazard ratio was computed from a restricted cubic spline model with a median QTa value of 416 ms as the referent group and was adjusted for age, sex, and race/ethnicity. Dotted-lines represent the 95% confidence interval. †QTa was computed with the following formula: QT + 2.38*(heart rate-60). AF=atrial fibrillation. ms=milliseconds
See this image and copyright information in PMC

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