Ventricular Ectopy and Heart Failure

Study Questions:

Does premature ventricular contraction (PVC) frequency on 24-hour Holter monitor predict left ventricular ejection fraction (LVEF) decline, incident heart failure (HF), and death in a population-based cohort?

Methods:

Participants of the Cardiovascular Health Study were randomly assigned to 24-hour Holter monitor. All participants underwent a medical history, physical exam, laboratory testing, and 12-lead electrocardiogram at enrollment. Patients with abnormal LVEF on echocardiograms or HF on baseline evaluation were excluded; 1,139 subjects contributed to the analysis. PVC frequency was quantified, and LVEF was measured on baseline and 5-year echocardiograms. Subjects were followed for incident HF and death.

Results:

Median follow-up was >13 years. After dividing participants into quartiles of PVC burden, subjects in the upper quartile (0.123%-17.7%) versus the lowest quartile (0.002%-0.123%) had adjusted threefold greater odds of a 5-year LVEF decline (95% confidence interval [CI], 1.42-6.77), a 48% increased risk of incident HF (95% CI, 1.08-2.04), and a 31% increased risk of death (95% CI, 1.06-1.63). The results were confirmed also when analyzing PVCs as a continuous variable. PVC burden of at least 0.7% of all ventricular beats had the specificity of 90% for the 15-year risk of HF. The population-level risk for incident HF attributed to PVCs was 8.1% (95% CI, 1.2-14.9).

Conclusions:

The authors concluded that a higher frequency of PVCs was associated with LVEF decline, increased incident HF, and increased mortality.

Perspective:

PVCs and cardiomyopathy often coexist. Reduction in systolic heart function has been associated with PVC burden exceeding 15–20% of all cardiac cycles in a 24-hour period. There is a growing number of nonrandomized reports showing that in some patients with PVCs and cardiomyopathy, the myopathic process improves after elimination of PVCs with ablation. There is, however, persistent uncertainty about whether the high PVC burden causes or is the result of cardiomyopathy. The current study is important because it shows high PVC burden to precede the onset of cardiomyopathy in a population-based cohort of Medicare-aged adults. While this repost does not prove causality, it is a very welcome piece of evidence in the circumstantial case of PVC cardiomyopathy.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, Acute Heart Failure, Echocardiography/Ultrasound

Keywords: Arrhythmias, Cardiac, Cardiomyopathies, Cost of Illness, Echocardiography, Electrocardiography, Ambulatory, Heart Defects, Congenital, Heart Failure, Mortality, Stroke Volume, Systole, Ventricular Premature Complexes


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