Key result
High-risk exercise VPCs are linked to ~27% higher all-cause mortality in asymptomatic patients.
Why the study?
Ventricular premature contractions are common during cardiac stress tests, but their independent prognostic value in asymptomatic patients is unclear.
Does the presence of high-risk ventricular premature complexes during exercise or recovery predict increased all-cause and cardiovascular mortality in asymptomatic patients?
Meta-Analysis (n=24,518)
Does the presence of high-risk ventricular premature complexes during exercise or recovery predict increased all-cause and cardiovascular mortality in asymptomatic patients?
In asymptomatic patients undergoing stress testing, high-risk VPCs during exercise independently predict all-cause and CV mortality, while high-risk VPCs during recovery predict CV mortality alone, indicating they serve as an important risk marker warranting further assessment.
Answers are grounded in this paper and cite their sources.
May prompt intensified risk-factor screening in asymptomatic patients; leaves open whether VPCs should guide interventions in trials.
Ventricular premature contractions (VPCs) are a common finding during cardiac stress tests. The independent prognostic value of these findings in patients in asymptomatic patients is unclear. We conducted a systematic review and meta-analysis of observational studies exploring the independent prognostic value of VPCs to predict all-cause mortality. The secondary outcome was cardiovascular (CV) mortality. We excluded studies that did not report outcomes after adjusting for ≥1 confounder. Random effect meta-analyses were used to predict cumulative hazard ratios. We stratified results based on VPC during exercise or recovery. We found 7 studies with 24,518 patients that met our inclusion criteria. Two studies reported all-cause mortality only, 1 study reported CV mortality only, rest 4 reported both. There was significant heterogeneity in the baseline population, definition of high-risk VPCs, and variables used in adjusted models. Using multivariable summary estimates from individual studies, only VPCs during exercise were associated with a higher risk of all-cause mortality (HR 1.27, 95 % CI 1.07, 1.48). Both VPCs during exercise and recovery were associated with a higher risk CV mortality (HR 1.69, 95 % CI 1.19, 2.20, I2 = 17.6 % and 1.62, 95 % CI 1.25, 2.00, p < 0.001 for both). High-risk VPCs during exercise is associated with increased risk of all-cause and CV mortality, while those during recovery are associated with an increased risk of CV mortality only.
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Gupta et al. (2023) conducted a meta-analysis in Asymptomatic patients undergoing exercise stress testing (n=24,518). High-risk ventricular premature complexes (VPCs) during exercise or recovery vs. Absence of high-risk VPCs was evaluated on All-cause mortality (HR 1.27, 95% CI 1.07-1.48, p=<0.001). High-risk ventricular premature complexes during exercise were independently associated with a 27% higher risk of all-cause mortality (HR 1.27, 95% CI 1.07-1.48) in asymptomatic patients.
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