title: Microvasculature and incident atrioventricular conduction abnormalities in the Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: 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.
authors.affiliation: Department of Vascular and Endovascular Surgery, Section on Vascular Medicine, Harbin Clinic, Rome, GA, USA bchacko@harbinclinic.com.
authors.forename: Billy G
authors.initials: BG
authors.lastname: Chacko
authors.affiliation: Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Edwards
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: A Richey
authors.initials: AR
authors.lastname: Sharrett
authors.affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Waqas T
authors.initials: WT
authors.lastname: Qureshi
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Barbara E K
authors.initials: BE
authors.lastname: Klein
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Herrington
authors.affiliation: Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology, Division of Public Health, Wake Forest School of Medicine, Winston-Salem, NC, USA.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
mesh_terms: D050197:Atherosclerosis / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D004562:Electrocardiography / Q000379:methods; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D055806:Microvessels / Q000002:abnormalities* / Q000502:physiology; D012171:Retinal Vessels / Q000002:abnormalities* / Q000502:physiology; D012306:Risk; D012307:Risk Factors
keywords: Arteriolar; cardiovascular disease; microcirculation