Chacko Billy G, Edwards Matthew S, Sharrett A Richey, Qureshi Waqas T, Klein Barbara E K, Klein Ronald, Herrington David M, Soliman Elsayed Z
Department of Vascular and Endovascular Surgery, Section on Vascular Medicine, Harbin Clinic, Rome, GA, USA
Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Vasc Med. 2015 Oct;20(5):417-23. doi: 10.1177/1358863X15586475. Epub 2015 May 21.
Abnormalities of the microvasculature are linked to major cardiac events, but their role in the development of atrioventricular conduction abnormalities (AVCA) is unknown. We examined the association between central retinal arteriolar equivalent (CRAE), a measure of the microvasculature, and incident AVCA. This analysis included 3975 participants free of AVCA at baseline from the Multi-Ethnic Study of Atherosclerosis (MESA). Incident AVCA was defined as a composite of new heart rate-adjusted PR interval ⩾ 200 ms (first-degree AV block) and advanced block (second-degree or complete AV block) detected from the MESA exam 5 electrocardiogram (ECG). CRAE was measured from retinal photographs at exam 2. Both ECGs and retinal photographs were collected using standardized methods and read and graded at central core labs. Incident AVCA were present in 7.4% (n=290) of the participants, of which 94% were first-degree AV block. Incident AVCA were increasingly more common in participants with narrower CRAE (4.6% in Q4, 6.4% in Q3, 7.0% in Q2 and 10.8% in Q1, p-value for trend < 0.0001). The socio-demographic and cardiovascular disease risk-adjusted odds of incident AVCA in the Q1 group (the group with the narrowest retinal arteriolar diameter) was nearly twice the odds in the Q4 group (OR: 1.68, 95% CI: 1.15-2.51). This association remained significant after adjustment for major ECG abnormalities and incident cardiovascular disease (Q1 vs Q4, OR: 1.65, 95% CI: 1.01-2.71). In conclusion, narrower retinal arteriolar caliber is associated with development of new AV conduction abnormalities.
微血管异常与重大心脏事件相关，但它们在房室传导异常（AVCA）发生发展中的作用尚不清楚。我们研究了微血管测量指标——视网膜中央动脉等效值（CRAE）与新发AVCA之间的关联。该分析纳入了动脉粥样硬化多族裔研究（MESA）中3975名基线时无AVCA的参与者。新发AVCA定义为从MESA第5次心电图（ECG）检查中检测到的新的心率校正PR间期≥200毫秒（一度房室传导阻滞）和高级别阻滞（二度或三度房室传导阻滞）的组合。CRAE在第2次检查时通过视网膜照片测量。ECG和视网膜照片均采用标准化方法收集，并由中央核心实验室进行读取和分级。7.4%（n = 290）的参与者出现新发AVCA，其中94%为一度房室传导阻滞。新发AVCA在CRAE较窄的参与者中越来越常见（四分位间距4中为4.6%，四分位间距3中为6.4%，四分位间距2中为7.0%，四分位间距1中为10.8%，趋势p值<0.0001）。在四分位间距1组（视网膜小动脉直径最窄的组）中，经社会人口统计学和心血管疾病风险调整后的新发AVCA几率几乎是四分位间距4组的两倍（比值比：1.68，95%置信区间：1.15 - 2.51）。在调整主要ECG异常和新发心血管疾病后，这种关联仍然显著（四分位间距1组与四分位间距4组相比，比值比：1.65，95%置信区间：1.01 - 2.71）。总之，视网膜小动脉管径变窄与新发房室传导异常的发生有关。
