Are late ventricular premature contractions associated with left ventricular function and infarct size in patients recovering from acute myocardial infarction?
Frequent or complex ventricular premature contractions in the convalescent phase of acute MI are strongly associated with larger infarct size and worse left ventricular function, suggesting they may be a marker of myocardial damage rather than an independent risk factor for sudden cardiac death.
Abnormalities of left ventricular function and extent of myocardial infarction were studied in relation to prevalence of late ventricular premature contractions (VPCs) in 36 patients in the convalescent stage of acute myocardial infarction (MI). Left ventricular ejection fraction (EF) and percent akinesis (%A) were calculated from gated cardiac blood pool scans; myocardial infarct size was estimated from peak CPK values; and VPCs were detected by 24 hour ambulatory ECGs 2-4 weeks following hospitalization for acute MI. Twenty-two patients had either zero (class 0) or less than 30/hour unifocal VPCs (class I). Fourteen patients had greater than 30/hour unifocal (class II), multifocal (class III) or coupled VPCs (class IV), including ventricular tachycardia. Thirteen of 14 class II-IV patients had EF less than 40% compared with only 8 of 22 class 0-I patients. Class II-IV patients had significantly lower mean EF (30.5 +/- 2.3 SE to 49.6 +/- 4.0) P less than 0.01, higher mean %A (28.1 +/- 2.2 to 16.9 +/- 3.7) P less than 0.05, and higher mean peak CPK (1350 +/- 187 to 721 +/- 155) P less than 0.05 than class 0-I patients. These data suggest that VPCs may not be an independent risk factor for sudden cardiac death in the convalescent phase of MI.
Schulze et al. (Mon,) studied this question.