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

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Abstract

Background

Prolongation of the QT interval is associated with an increased risk of atrial fibri llation (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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Acknowledgments

The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. This research was supported by contracts N01-HC-95159 through N01-HC-95169 from the National Heart, Lung, and Blood Institute and by grants UL1-RR-024156 and UL1-RR-025005 from NCRR.

Conflict of interest

Dr. Nazarian is a consultant and principal investigator for research funding awarded to Johns Hopkins University from Biosense Webster Inc.

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Authors and Affiliations

  1. Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA

    Wesley T. O’Neal

  2. Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC, USA

    Jimmy T. Efird

  3. Department of Neurology, Cornell University School of Medicine, New York, NY, USA

    Hooman Kamel

  4. Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Saman Nazarian

  5. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA

    Alvaro Alonso

  6. Cardiovascular Health Research Unit, Department of Epidemiology, University of Washington, and Group Health Research Institute, Seattle, WA, USA

    Susan R. Heckbert

  7. Departments of Neurology and Epidemiology, University of Washington School of Medicine, Seattle, WA, USA

    W. T. Longstreth Jr.

  8. Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Elsayed Z. Soliman

  9. Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Elsayed Z. Soliman

Authors
  1. Wesley T. O’Neal
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  2. Jimmy T. Efird
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  3. Hooman Kamel
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  4. Saman Nazarian
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  6. Susan R. Heckbert
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  7. W. T. Longstreth Jr.
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  8. Elsayed Z. Soliman
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Correspondence to Wesley T. O’Neal.

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O’Neal, W.T., Efird, J.T., Kamel, H. et al. The association of the QT interval with atrial fibrillation and stroke: the Multi-Ethnic Study of Atherosclerosis. Clin Res Cardiol 104, 743–750 (2015). https://doi.org/10.1007/s00392-015-0838-z

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  • DOI: https://doi.org/10.1007/s00392-015-0838-z

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