High-grade PVCs during recovery from exercise testing were associated with increased cardiovascular mortality in asymptomatic individuals (HR 1.68; 95% CI 1.09-2.60; p=0.020).
Cohort (n=5,486)
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Does the presence of high-grade premature ventricular contractions during exercise stress testing predict cardiovascular mortality in asymptomatic individuals?
High-grade PVCs occurring during the recovery phase of exercise stress testing, but not during exercise itself, are associated with an increased long-term risk of cardiovascular mortality in asymptomatic individuals.
Hazard Ratio: 1.68 (95% CI 1.09–2.6)
valor p: p=0.020
Background: The prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear. Objectives: To investigate if high-grade PVCs during stress testing predict mortality in asymptomatic individuals. Methods: 5,486 asymptomatic individuals who took part in the Lipid Research Clinics prospective cohort had baseline interview, physical examination, blood tests, and underwent Bruce protocol treadmill testing. Adjusted Cox survival models evaluated the association of exercise-induced high-grade PVCs (defined as either frequent (>10/min), multifocal, R-on-T type, or ≥ 2 PVCs in a row) with all-cause and cardiovascular mortality. Results: Mean baseline age was 45.4 ± 10.8 years; 42% were women. During a mean follow-up of 20.2 ± 3.9 years, 840 deaths occurred, including 311 cardiovascular deaths. High-grade PVCs occurred during exercise in 1.8% of individuals, during recovery in 2.4%, and during both in 0.8%. After adjusting for age, sex, diabetes, hypertension, lipids, smoking, body mass index, and family history of premature coronary disease, high-grade PVCs during recovery were associated with cardiovascular mortality (HR=1.82, 95% CI 1.19–2.79, p=0.006) which remained significant after further adjusting for exercise duration, heart rate recovery, achieving target heart rate, and ST depression (HR=1.68, 95% CI 1.09–2.60, p=0.020). Results were similar by clinical subgroups. High-grade PVCs occurring during the exercise phase were not associated with increased risk. Recovery PVCs did not improve 20-year cardiovascular mortality risk discrimination beyond clinical variables. Conclusion: High-grade PVCs occurring during recovery were associated with long-term risk of cardiovascular mortality in asymptomatic individuals, while PVCs occurring only during exercise were not associated with increased risk.
“Currently, most clinicians tend to ignore PVCs that occur during stress testing, but here we showed that PVCs that occurred in recovery — in particular if they are two or more in a row, frequent, multifocal, or R-on-T — identified higher-risk asymptomatic individuals who may benefit from further intensifying preventive efforts. Importantly, the risk carried by these high-grade PVCs — approximately 80% higher CV mortality risk — was independent of standard risk factors or even other exercise testing variables, and mostly identified individuals who were more likely to die from CVD after 10 years of follow-up. This was in contrast to PVCs that occurred only during exercise, which were not associated with increased risk after accounting for other CV or exercise test variables.”
Refaat et al. (Mon,) conducted a cohort in Asymptomatic individuals (n=5,486). High-grade premature ventricular contractions (PVCs) during recovery vs. Absence of high-grade PVCs during recovery was evaluated on Cardiovascular mortality (HR 1.68, 95% CI 1.09-2.60, p=0.020). High-grade PVCs during recovery from exercise testing were associated with increased cardiovascular mortality in asymptomatic individuals (HR 1.68; 95% CI 1.09-2.60; p=0.020).