Clinical impact of long PR-interval and presence of late gadolinium
enhancement on hospitalized patients with non-ischemic heart failure
Abstract
Background: The combination of electrical and structural remodeling may
have a strong effect on the prognosis of non-ischemic heart failure
(HF). We aimed to clarify whether prolonged PR-interval and the presence
of late gadolinium enhancement (LGE) on cardiac magnetic resonance
imaging (CMR) influence the outcomes of patients with non-ischemic HF.
Methods: We studied 262 consecutive hospitalized patients with
non-ischemic HF. In a clinically stable condition, a 12-lead
electrocardiogram and CMR were performed, and the clinical
characteristics and outcomes were investigated. Results: During the
follow-up of 967.7±851.8 days, there were 68 (25.9%) cardiac events (HF
or sudden death, re-hospitalization due to HF, or ventricular
tachyarrhythmias). In a multivariable analysis, a median rate-adjusted
PR (PRa)-interval of ≥173.5 ms and the presence of LGE were associated
with cardiac events with a hazard ratio of 1.690 and 2.045 (P=0.044 and
P=0.006, respectively). Study subjects were then divided into three
groups based on PRa-interval and LGE status. The patients were given 1
point each for PRa-interval of ≥173.5 ms and the presence of LGE: score
of 0 (n=79), score of 1 (n=123) and score of 2 (n=60). Cardiac events
were 16.4% in score of 0, 26.0% in score of 1 and 38.3% in score of 2
(P=0.005), respectively. The multivariable analysis showed that score of
2 was an independent predictor for cardiac events compared to score of 0
(hazard ratio, 3.437, P=0.001). Conclusions: The combination of a long
PRa-interval and the presence of LGE provides a better predictive value
of cardiac events in non-ischemic HF.