Author + information
- Billy G. Chacko,
- Matthew Edwards,
- A Richey Sharrett,
- Barbara E. Klein,
- Ronald Z. Klein,
- David Herrington and
- Elsayed Soliman
Atrioventricular (AV) conduction delay and retinal vessel changes are associated with heart failure, however, the role of microvasculature in the development of cardiac conduction abnormalities has not been explored. We examined the association between retinal arteriolar caliber, with incident AV conduction abnormalities in individuals enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA).
This analysis included 3,975 participants (Age 59.7+9.3 years, 54% females) with good quality electrocardiograms at both the MESA baseline and 8 year follow up exams as well as good quality retinal photographs. We excluded participants with baseline AV conduction delay. Retinal arteriolar caliber was measured as the central retinal arteriolar equivalent (CRAE). Incident AV conduction abnormalities were defined as presence of new heart rate adjusted PR≥200 ms (first degree AV block) or advanced AV block (second degree or complete AV block) at 8 years. Multivariable logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals for incident AV conduction delays associated with each quartile of baseline CRAE.
Incident AV conduction abnormalities were present in 7.4% (N=295) of the participants at 8 years, of which 89.8% were first degree AV block. Incident AV conduction delays were increasingly common in subjects with smaller retinal arteriolar diameters (10.9% in Q1, 7.8% in Q2, 6.4% Q3 and 4.7% in Q4). The odds of incident AV conduction delay in the Q1 group (the group with the narrowest CRAE) was more than double the odds in Q4 (p<0.0001). This strong association persisted after adjustment for baseline demographics and potential confounders (p=0.018). Further adjustment for retinal venular caliber resulted in OR1.61 (1.04-2.52) p=0.03. There were no interactions by gender, diabetes or hypertension status.
Narrower retinal arteriolar caliber is independently associated with development of new AV conduction abnormalities. These findings suggest a role of the microvasculature in the development of AV conduction abnormalities in individuals with no clinically manifest cardiovascular disease.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: Atrial Physiology and Ablation of Atrial Arrhythmias
Abstract Category: 6. Arrhythmias: Other
Presentation Number: 1238-51
- 2013 American College of Cardiology Foundation