Long-Term Outcome in Asymptomatic Men with Exercise-Induced Premature Ventricular Depolarizations

BACKGROUND: Exercise testing is widely used in the diagnosis of coronary artery disease, but the long-term outcome for asymptomatic persons with exercise-induced premature ventricular depolarizations remains unclear. We used data from the Paris Prospective Study I to assess the long-term outcome for such persons. METHODS: A total of 6101 asymptomatic French men (42 to 53 years of age) who were free of clinically detectable cardiovascular disease underwent a standardized graded exercise test between 1967 and 1972. Subjects were prospectively classified as having or not having frequent premature ventricular depolarizations (a run of two or more consecutive premature ventricular depolarizations or premature ventricular depolarizations constituting more than 10 percent of all ventricular depolarizations during any of the 30-second electrocardiographic recordings). RESULTS: During exercise, 138 subjects had frequent premature ventricular depolarizations. After 23 years of follow-up, these subjects had a higher risk of death from cardiovascular causes than the men without frequent premature ventricular depolarizations during exercise (relative risk, 2.67; 95 percent confidence interval, 1.76 to 4.07). In a multivariate model, with adjustment for age, body-mass index, heart rate at rest, systolic blood pressure, tobacco use, level of physical activity, presence or absence of diabetes, total cholesterol level, and the presence or absence of premature ventricular depolarizations before exercise and during recovery from exercise, both an exercise test that was positive for ischemia and the occurrence of frequent premature ventricular depolarizations during exercise remained independently associated with an increased risk of death from cardiovascular causes, with similar relative risks (2.63 95 percent confidence interval, 1.93 to 3.59 and 2.53 95 percent confidence interval, 1.65 to 3.88, respectively). CONCLUSIONS: The occurrence of frequent premature ventricular depolarizations during exercise in asymptomatic middle-aged men is associated with a long-term increase in the risk of death from cardiovascular causes.