A Surprising Shield: How a Common Heart Rhythm Marker May Protect Against Repeat Strokes
A secondary analysis of the ARCADIA trial, which studied patients who had a cryptogenic stroke and evidence of atrial cardiopathy, has revealed a counterintuitive finding. While a prolonged QT interval on an ECG is a known risk factor for a first stroke in the general population, in this specific patient group it was associated with a significantly lower risk of having a recurrent stroke. After adjusting for other factors, patients with a prolonged QT interval had a 72% lower hazard of another stroke per standard deviation increase, and an 84% lower risk when comparing prolonged to normal QT intervals. This protective association held true across multiple standard formulas for correcting the QT interval for heart rate.
Why it might matter to you:
This finding challenges the conventional risk stratification for stroke recurrence, particularly in patients with complex cardiometabolic profiles common in diabetes. It suggests that ECG markers may have differential prognostic value for first versus subsequent vascular events. For clinicians managing patients with diabetes who are at high risk for both microvascular and macrovascular complications, this highlights the need for nuanced, context-specific interpretation of common diagnostic tests when assessing secondary prevention strategies.
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