Key result
PVCs during exercise recovery linked to ~230% higher CV mortality only with concomitant echocardiographic abnormalities.
Why the study?
Premature ventricular contractions during recovery of exercise stress testing are linked to increased cardiovascular mortality, but the underlying cause remains unknown.
Does the presence of PVCs during exercise recovery predict cardiovascular mortality in adults undergoing exercise stress testing and echocardiography?
Cohort (n=3,106)
No
Does the presence of PVCs during exercise recovery predict cardiovascular mortality in adults undergoing exercise stress testing and echocardiography?
Exercise-induced PVCs during recovery are associated with increased cardiovascular mortality only when concomitant echocardiographic abnormalities are present, suggesting structural heart disease mediates this risk.
Answers are grounded in this paper and cite their sources.
PVCs during recovery signal mortality risk only with echo abnormalities; leaves open whether targeted imaging improves risk stratification.
Background Premature ventricular contractions (PVCs) during recovery of exercise stress testing are associated with increased cardiovascular mortality, but the cause remains unknown. We aimed to evaluate the association of PVCs during recovery with echocardiographic abnormalities, and their combined prognostic performance. Methods Echocardiographic abnormalities (reduced left ventricular (LV) ejection fraction, valvular heart disease, LV dilatation, LV hypertrophy, or increased filling pressures) and PVCs during recovery (≥1/min) were identified among patients having undergone echocardiography within median [interquartile range] 0 [0-2] days of an exercise stress test. The association between such changes and cardiovascular mortality was analyzed using Cox regression adjusted for age, sex, clinical and exercise variables. Results Among included patients (n=3,106), PVCs during recovery were found in 1,327 (43%) patients, among which the prevalence of echocardiographic abnormalities was increased (58% vs. 44%, p<0.001). Overall, PVCs during recovery were associated with increased cardiovascular mortality (219 total events, 7.9 [5.4–11.1] years follow-up; adjusted hazard ratio (HR [95% confidence interval]) 1.6 [1.2–2.1], p<0.001). When combined with echocardiographic abnormalities, PVCs during recovery were associated with increased risk when such were present (HR 3.3 [1.9–5.5], p<0.001) but not when absent (HR 1.5 [0.8–2.8], p=0.22), in reference to those with neither. Conclusion PVCs during recovery were associated with increased prevalence of echocardiographic abnormalities. Increased risk of cardiovascular mortality was observed only for subjects with PVCs if concomitant echocardiographic abnormalities were present. Our findings provide mechanistic insights to the increased CV risk reported in patients with PVCs during recovery.
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Lindow et al. (2021) conducted a cohort in Patients undergoing exercise stress testing and echocardiography (n=3,106). Premature ventricular contractions (PVCs) during recovery and echocardiographic abnormalities vs. No PVCs during recovery and no echocardiographic abnormalities was evaluated on Cardiovascular mortality (HR 3.3, 95% CI 1.9-5.5, p=<0.001). Premature ventricular contractions during exercise recovery were associated with increased cardiovascular mortality only when concomitant echocardiographic abnormalities were present.
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