Key result
Exercise-induced ventricular arrhythmias in genetic DCM linked to ~32-point higher risk of adverse outcomes.
Why the study?
The clinical relevance of PVCs and NSVT during exercise stress testing in patients with genetic DCM is unknown. It was unclear whether these arrhythmias represent early disease manifestations, reflect a more advanced phenotype, or provide prognostic information.
Does the occurrence of PVCs or NSVT during exercise stress testing predict adverse clinical outcomes and structural abnormalities in adults with a (likely-)pathogenic variant in a DCM-associated gene?
Cohort (n=294)
No
Does the occurrence of PVCs or NSVT during exercise stress testing predict adverse clinical outcomes and structural abnormalities in adults with a (likely-)pathogenic variant in a DCM-associated gene?
In patients with genetic dilated cardiomyopathy, exercise-induced PVCs or NSVT are strongly associated with baseline myocardial fibrosis and long-term adverse clinical outcomes, supporting the use of exercise stress testing for diagnostic evaluation and risk stratification even in asymptomatic carriers.
Answers are grounded in this paper and cite their sources.
Exercise-induced PVCs/NSVT may aid risk stratification in genetic DCM; leaves open prospective validation before guiding management.
Background and Aims The clinical relevance of premature ventricular contractions (PVCs) and non-sustained ventricular tachycardia (NSVT) during exercise stress testing (EST) in patients with genetic dilated cardiomyopathy (DCM) is unknown. It is particularly unclear whether these arrhythmias represent early manifestations of disease, reflect a more advanced phenotype, or provide prognostic information. Methods We conducted a retrospective single-center cohort study in adults with a (likely-)pathogenic variant in a DCM-associated gene who underwent an EST. Associations between ≥1 PVC or NSVT occurring during exercise or recovery phases, baseline clinical characteristics, structural abnormalities on transthoracic echocardiography or cardiac magnetic resonance imaging, and clinical outcomes were assessed using multivariable regression models. Clinical outcomes comprised: (1) sudden cardiac death or malignant ventricular arrhythmias, (2) DCM progression, and (3) initiation or intensification of heart-failure therapy or device implantation. Results A total of 294 patients were included, of whom 74% relatives and 56% asymptomatic at baseline. PVC/NSVT during EST occurred in 163 patients (55%) and were independently associated with age (OR 1.024; P=0.027) and late gadolinium enhancement on cardiac magnetic resonance imaging (OR 3.698; P=0.002). During a median follow-up of 70 months, patients with PVC/NSVT more often reached the composite outcome than those without (79.7% vs. 48.2%; P<0.001). In multivariable Cox regression analyses, PVC/NSVT during EST were independently associated with the composite outcome (P<0.001), with consistent associations across individual outcomes. These associations were also observed in relatives and patients who were asymptomatic at baseline. PVCs and NSVT were both prognostically relevant, with stronger associations observed for NSVT. Conclusion In genetic DCM, PVC or NSVT during EST are associated with myocardial fibrosis at baseline and adverse clinical outcomes during follow-up. EST provides complementary information for diagnostic evaluation and risk stratification in patients with genetic DCM, including those without overt phenotype.
No takes yet. Share an insight, caveat, or question.
Kalf et al. (2026) conducted a cohort in Genetic dilated cardiomyopathy (DCM) (n=294). Exercise-induced ≥1 PVC or NSVT during exercise or recovery phases vs. No PVC or NSVT during exercise stress testing was evaluated on Composite of sudden cardiac death or malignant ventricular arrhythmias, DCM progression, and initiation or intensification of heart-failure therapy or device implantation (p=<0.001). Exercise-induced PVCs or NSVT in genetic DCM patients were associated with higher rates of the composite adverse clinical outcome vs no arrhythmias (79.7% vs 48.2%; P<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: