The association of the QT interval with atrial fibrillation and stroke

the Multi-Ethnic Study of Atherosclerosis

Wesley T. O’Neal, Jimmy T. Efird, Hooman Kamel, Saman Nazarian, Alvaro Alonso, Susan R. Heckbert, W. T. Longstreth, Elsayed Z. Soliman

Research output: Contribution to journalArticle

9 Citations (Scopus)

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 (QTa). Prolonged QTa 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 QTa and stroke with and without AF. Results: A total of 216 (3.4 %) of study participants had prolonged QTa. 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 QTa 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 QTa 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.

Original languageEnglish (US)
Pages (from-to)743-750
Number of pages8
JournalClinical Research in Cardiology
Volume104
Issue number9
DOIs
StatePublished - Sep 26 2015

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Atrial Fibrillation
Atherosclerosis
Stroke
Hospital Records
Medicare
Hispanic Americans
Medical Records
Blood Vessels
Heart Rate
Regression Analysis
Demography
Research

Keywords

  • Atrial fibrillation
  • Long QT
  • Stroke

Cite this

O’Neal, W. T., Efird, J. T., Kamel, H., Nazarian, S., Alonso, A., Heckbert, S. R., ... Soliman, E. Z. (2015). The association of the QT interval with atrial fibrillation and stroke: the Multi-Ethnic Study of Atherosclerosis. Clinical Research in Cardiology, 104(9), 743-750. https://doi.org/10.1007/s00392-015-0838-z

The association of the QT interval with atrial fibrillation and stroke : the Multi-Ethnic Study of Atherosclerosis. / O’Neal, Wesley T.; Efird, Jimmy T.; Kamel, Hooman; Nazarian, Saman; Alonso, Alvaro; Heckbert, Susan R.; Longstreth, W. T.; Soliman, Elsayed Z.

In: Clinical Research in Cardiology, Vol. 104, No. 9, 26.09.2015, p. 743-750.

Research output: Contribution to journalArticle

O’Neal, WT, Efird, JT, Kamel, H, Nazarian, S, Alonso, A, Heckbert, SR, Longstreth, WT & Soliman, EZ 2015, 'The association of the QT interval with atrial fibrillation and stroke: the Multi-Ethnic Study of Atherosclerosis', Clinical Research in Cardiology, vol. 104, no. 9, pp. 743-750. https://doi.org/10.1007/s00392-015-0838-z
O’Neal, Wesley T. ; Efird, Jimmy T. ; Kamel, Hooman ; Nazarian, Saman ; Alonso, Alvaro ; Heckbert, Susan R. ; Longstreth, W. T. ; Soliman, Elsayed Z. / The association of the QT interval with atrial fibrillation and stroke : the Multi-Ethnic Study of Atherosclerosis. In: Clinical Research in Cardiology. 2015 ; Vol. 104, No. 9. pp. 743-750.
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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 (QTa). Prolonged QTa 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 QTa and stroke with and without AF. Results: A total of 216 (3.4 {\%}) of study participants had prolonged QTa. 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 QTa 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 QTa 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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AU - Nazarian, Saman

AU - Alonso, Alvaro

AU - Heckbert, Susan R.

AU - Longstreth, W. T.

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N2 - 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 (QTa). Prolonged QTa 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 QTa and stroke with and without AF. Results: A total of 216 (3.4 %) of study participants had prolonged QTa. 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 QTa 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 QTa 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.

AB - 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 (QTa). Prolonged QTa 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 QTa and stroke with and without AF. Results: A total of 216 (3.4 %) of study participants had prolonged QTa. 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 QTa 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 QTa 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.

KW - Atrial fibrillation

KW - Long QT

KW - Stroke

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