State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, China.
BMC Cardiovasc Disord. 2023 Mar 8;23(1):119. doi: 10.1186/s12872-022-03028-3.
Previous reports on the epidemiology, influencing factors, and the prognostic value of the components of PR interval in hospitalized heart failure patients were limited.
This study retrospectively enrolled 1182 patients hospitalized with heart failure from 2014 to 2017. Multiple linear regression analysis was used to explore the association between the components of PR interval and the baseline parameters. The primary outcome was all-cause death or heart transplantation. Multivariable-adjusted Cox proportional hazard regression models were constructed to explore the predictive value of the components of PR interval for the primary outcome.
In multiple linear regression analysis, higher height (for every 10 cm increase in height: regression coefficient 4.83, P < 0.001) as well as larger atrial and ventricular size were associated with larger P wave duration but not with PR segment. The primary outcome occurred in 310 patients after an average follow-up of 2.39 years. Cox regression analyses revealed that the increase in PR segment was an independent predictor of the primary outcome (every 10 ms increase: hazard ratio 1.041, 95% confidence interval [CI] 1.010-1.083, P = 0.023), whereas the P wave duration did not show significant correlation. When adding the PR segment to an initial prognostic prediction model, the likelihood ratio test and categorical net reclassification index (NRI) showed a significant improvement, but the increase in C-index was not significant. In subgroup analysis, increased PR segment was an independent predictor of the primary endpoint in patients taller than 170 cm (each 10 ms increase: hazard ratio 1.153, 95% CI 1.085-1.225, P < 0.001) but not the shorter group (P for interaction = 0.006).
In hospitalized patients with heart failure, longer PR segment was an independent predictor of the composite endpoint of all-cause death and heart transplantation, especially in the taller group, but it had limited significance in improving the prognostic risk stratification of this population.
以前关于住院心力衰竭患者 PR 间期各组成部分的流行病学、影响因素和预后价值的报告有限。
本研究回顾性纳入了 2014 年至 2017 年期间因心力衰竭住院的 1182 例患者。采用多元线性回归分析探讨 PR 间期各组成部分与基线参数之间的关系。主要终点为全因死亡或心脏移植。构建多变量调整 Cox 比例风险回归模型，探讨 PR 间期各组成部分对主要终点的预测价值。
在多元线性回归分析中，身高较高（身高每增加 10cm：回归系数 4.83，P<0.001）以及心房和心室较大与 P 波持续时间较长有关，但与 PR 段无关。平均随访 2.39 年后，310 例患者发生主要终点事件。Cox 回归分析显示，PR 段的增加是主要终点事件的独立预测因素（每增加 10ms：风险比 1.041，95%置信区间[CI] 1.010-1.083，P=0.023），而 P 波持续时间与主要终点事件无显著相关性。当将 PR 段加入初始预后预测模型时，似然比检验和分类净重新分类指数（NRI）显示有显著改善，但 C 指数的增加不显著。在亚组分析中，在身高大于 170cm 的患者中，PR 段的增加是主要终点事件的独立预测因素（每增加 10ms：风险比 1.153，95%CI 1.085-1.225，P<0.001），而在身高较短的患者中则不是（P 交互检验=0.006）。
在住院心力衰竭患者中，PR 段较长是全因死亡和心脏移植复合终点的独立预测因素，尤其是在身高较高的患者中，但对该人群的预后风险分层改善意义有限。
