Key result
High-burden premature ventricular contractions (≥20% on Holter monitoring) were associated with a significantly increased odds of heart failure (OR 3.15; 95% CI 1.28-6.50; P=0.005).
Why the study?
What are the characteristics and predictors of heart failure in unselected patients with high-burden premature ventricular contractions?
Case-Control (n=5,091)
No
What are the characteristics and predictors of heart failure in unselected patients with high-burden premature ventricular contractions?
Odds Ratio: 3.15 (95% CI 1.28–6.5)
p-value: p=0.005
High-burden PVCs (≥20%) are rare (1.3%) in unselected patients undergoing Holter monitoring but are strongly associated with heart failure and a family history of sudden death.
High-burden PVCs may warrant HF evaluation on Holter; leaves open causal role and suppression benefit.
BACKGROUND: High-burden premature ventricular contractions (PVCs) may be an important determinant of heart failure (HF) in patients presenting for PVC ablation. The prevalence and characteristics of high-burden PVC patients outside this setting remain unknown. We, therefore, sought to determine predictors of high-burden PVCs and, among high-burden PVC patients, predictors of HF. METHODS: We identified all patients undergoing a 24-48-hour Holter study showing at least 20% PVCs between 2005 and 2013 at the University of California, San Francisco. Three time-matched controls undergoing Holter monitoring were selected for each high-burden PVC patient. Medical records were reviewed and test characteristics of PVC counts from 12-lead electrocardiograms (ECG) as predictors of high-burden PVC Holters were analyzed. RESULTS: Among 5,091 participants, 66 (1.3%) exhibited at least 20% PVCs. After multivariate adjustment, high-burden PVC patients had a three-fold greater odds of HF (odds ratio [OR] 3.15; 95% confidence interval [CI] 1.28-6.50; P = 0.005) and 10-fold greater odds of having a first-degree family member with sudden death (OR 9.97; 95% CI 1.78-60.8; P = 0.011). The C-statistic for the number of PVCs on 12-lead electrocardiogram as a predictor of high-burden PVCs was 0.7949. Among high-burden PVC patients, HF was associated with a history of coronary artery bypass grafting (OR 11.76; 95% CI 1.30-106.49; P = 0.028). CONCLUSION: Among all undergoing Holter monitoring, 1.3% exhibited high-burden PVCs, a phenomenon associated with HF and a first-degree family history of sudden death. In an analysis restricted to high-burden PVC patients, a history of coronary artery bypass grafting was a predictor of HF.
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Yang et al. (2014) conducted a case-control in High-burden premature ventricular contractions (n=5,091). High-burden premature ventricular contractions (≥20% PVCs) vs. Controls without high-burden PVCs was evaluated on Heart failure (OR 3.15, 95% CI 1.28-6.50, p=0.005). High-burden premature ventricular contractions (≥20% on Holter monitoring) were associated with a significantly increased odds of heart failure (OR 3.15; 95% CI 1.28-6.50; P=0.005).
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