Key result
During exercise stress testing, a first VPC at ≥10 mets strongly predicted the presence of CPVT compared to healthy subjects (OR 9.1; 95% CI 2.01-41.1; P=0.004).
Why the study?
Do electrocardiographic characteristics of VPCs during exercise stress test distinguish patients with CPVT from healthy subjects?
Case-Control (n=52)
Do electrocardiographic characteristics of VPCs during exercise stress test distinguish patients with CPVT from healthy subjects?
Odds Ratio: 9.1 (95% CI 2.01–41.1)
p-value: p=0.004
Specific ECG characteristics of VPCs during exercise stress testing, such as QRS duration >120 ms and first VPC at ≥10 METs, can help distinguish CPVT patients from healthy subjects.
May support VPC-based CPVT differentiation on exercise testing; leaves open prospective validation before clinical adoption.
BACKGROUND: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare but highly malignant inherited arrhythmic disorder. Although a standardized exercise stress test (ST) is the most reliable way to diagnose CPVT, in 30% only single ventricular premature beats (VPCs) were recorded. OBJECTIVE: To evaluate whether electrocardiographic characteristics of VPCs during ST distinguish patients with CPVT from healthy subjects. METHODS: Electrocardiographic characteristics of VPCs during ST in 16 calsequestrin-2 (CASQ2) mutation carriers CPVT patients were compared with that in 36 healthy subjects. RESULTS: CPVT patients had more VPCs (31 ± 14 vs 3 ± 4, P < 0.0001), longer QRS duration (139 ± 18 ms vs 121 ± 21, P = 0.004), and coupling interval (CI; 476 ± 58 ms vs 355 ± 61 ms, P < 0.0001). The most sensitive characteristics for CPVT were >10 VPCs/test (100% sensitivity, 100% negative predictive value [NPV]), left bundle branch block (LBBB) pattern with inferior axis (88% sensitivity, 94% NPV), and CI longer than 400 ms (88% sensitivity, 94% NPV). Bigeminy or trigeminy or LBBB pattern with inferior axis was most specific for CPVT at 100% (100% positive predictive value PPV, 92% NPV). First VPC during the recovery period and VPC recording more than 1 minute during the recovery period were most specific for healthy subjects (100% specificity, 100% PPV). In multivariate analysis, QRS duration >120 ms (odds ratio 4.2, 95% confidence interval 1-17.6, P = 0.04) and first VPC at ≥10 mets (odds ratio 9.1, 95% confidence interval 2.01-41.1, P = 0.004) each predicted the presence of CPVT. CONCLUSIONS: Several electrocardiographic criteria can help distinguish VPCs originating from CPVT compared with healthy subjects.
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Blich et al. (2015) conducted a case-control in Catecholaminergic polymorphic ventricular tachycardia (CPVT) (n=52). First VPC at ≥10 mets during exercise stress test vs. Healthy subjects was evaluated on Presence of CPVT (OR 9.1, 95% CI 2.01-41.1, p=0.004). During exercise stress testing, a first VPC at ≥10 mets strongly predicted the presence of CPVT compared to healthy subjects (OR 9.1; 95% CI 2.01-41.1; P=0.004).
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