Key result
Reduced left ventricular inflow E wave flow during premature ventricular contractions was independently associated with PVC-related symptoms (9.3 vs. 14.6 cm, p<0.0001).
Why the study?
Premature ventricular contractions are a common arrhythmia with unclear causative mechanisms, prompting investigation into hemodynamic features causing symptomatic PVCs.
Does reduced PVC E wave flow correlate with PVC-related symptoms in patients with frequent monomorphic PVCs and no structural heart disease?
Cross-Sectional (n=109)
No
Does reduced PVC E wave flow correlate with PVC-related symptoms in patients with frequent monomorphic PVCs and no structural heart disease?
Effect estimate: OR 1.134029 (95% CI 1.040726-1.247544)
Absolute Event Rate: 9.3% vs 14.6%
p-value: p=0.00349
Decreased left ventricular E wave flow during premature ventricular contractions is independently associated with PVC-related symptoms, suggesting inadequate ventricular filling may contribute to symptom generation.
Should not yet change PVC management; supports hypothesis that reduced filling contributes to symptoms but requires prospective confirmation.
BACKGROUND: Because premature ventricular contractions (PVCs) are one of the most common arrhythmias, but with unclear causative mechanisms, we studied the hemodynamic features that can cause symptomatic PVCs. METHODS AND RESULTS: We studied 109 patients (48 males, age 60±19 years) with frequent monomorphic PVCs and no structural heart disease. The left ventricular inflow diastolic filling velocity was recorded by transthoracic echocardiography (TTE) at the time of PVCs in all patients. We assessed the PVC E wave flow (E wave velocity×duration at PVC). A total of 38 patients (35%) had PVC-related symptoms (19 palpitations, 12 pulse deficit, 6 shortness of breath, 6 malaise, 1 syncope). These patients showed reduced PVC E wave flow (9.3±6.0 vs. 14.6±6.5 cm, P<0.0001), and reduced PVC stroke volume (20.5±10.8 vs. 29.9±17.2 mL, P=0.0030). In the multivariate analysis, only reduced PVC E wave flow was independently associated with PVC-related symptoms (P=0.00349, odds ratio: 1.134029, each 1.0 cm increase in PVC E wave flow, 95% confidence interval: 1.040726-1.247544). CONCLUSIONS: Decreased E wave flow at the time of PVC was independently related with PVC-related symptoms in patients with PVCs. The LV contraction at the time of inadequate filling might be a cause of PVC-related symptoms.
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Takahashi et al. (2019) conducted a cross-sectional in Frequent monomorphic premature ventricular contractions (PVCs) (n=109). Symptomatic PVCs vs. Asymptomatic PVCs was evaluated on PVC E wave flow (OR 1.134029, 95% CI 1.040726-1.247544, p=0.00349). Reduced left ventricular inflow E wave flow during premature ventricular contractions was independently associated with PVC-related symptoms (9.3 vs. 14.6 cm, p<0.0001).
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