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Ventricular Ectopy as a Predictor of Heart Failure and Death.
Monday,2015-08-03 12:29 America/Los_Angeles — zdrager
| Title | Ventricular Ectopy as a Predictor of Heart Failure and Death. |
| Publication Type | Journal Article |
| Year of Publication | 2015 |
| Authors | Dukes, JW, Dewland, TA, Vittinghoff, E, Mandyam, MC, Heckbert, SR, Siscovick, DS, Stein, PK, Psaty, BM, Sotoodehnia, N, Gottdiener, JS, Marcus, GM |
| Journal | J Am Coll Cardiol |
| Volume | 66 |
| Issue | 2 |
| Pagination | 101-9 |
| Date Published | 2015 Jul 14 |
| ISSN | 1558-3597 |
| Keywords | Aged, Catheter Ablation, Echocardiography, Electrocardiography, Ambulatory, Female, Forecasting, Heart Failure, Humans, Male, Risk Factors, Stroke Volume, Ventricular Premature Complexes |
| Abstract | <p><b>BACKGROUND: </b>Studies of patients presenting for catheter ablation suggest that premature ventricular contractions (PVCs) are a modifiable risk factor for congestive heart failure (CHF). The relationship among PVC frequency, incident CHF, and mortality in the general population remains unknown.</p><p><b>OBJECTIVES: </b>The goal of this study was to determine whether PVC frequency ascertained using a 24-h Holter monitor is a predictor of a decrease in the left ventricular ejection fraction (LVEF), incident CHF, and death in a population-based cohort.</p><p><b>METHODS: </b>We studied 1,139 Cardiovascular Health Study (CHS) participants who were randomly assigned to 24-h ambulatory electrocardiography (Holter) monitoring and who had a normal LVEF and no history of CHF. PVC frequency was quantified using Holter studies, and LVEF was measured from baseline and 5-year echocardiograms. Participants were followed for incident CHF and death.</p><p><b>RESULTS: </b>Those in the upper quartile versus the lowest quartile of PVC frequency had a multivariable-adjusted, 3-fold greater odds of a 5-year decrease in LVEF (odds ratio [OR]: 3.10; 95% confidence interval [CI]: 1.42 to 6.77; p = 0.005), a 48% increased risk of incident CHF (HR: 1.48; 95% CI: 1.08 to 2.04; p = 0.02), and a 31% increased risk of death (HR: 1.31; 95% CI: 1.06 to 1.63; p = 0.01) during a median follow-up of >13 years. Similar statistically significant results were observed for PVCs analyzed as a continuous variable. The specificity for the 15-year risk of CHF exceeded 90% when PVCs included at least 0.7% of ventricular beats. The population-level risk for incident CHF attributed to PVCs was 8.1% (95% CI: 1.2% to 14.9%).</p><p><b>CONCLUSIONS: </b>In a population-based sample, a higher frequency of PVCs was associated with a decrease in LVEF, an increase in incident CHF, and increased mortality. Because of the capacity to prevent PVCs through medical or ablation therapy, PVCs may represent a modifiable risk factor for CHF and death.</p> |
| DOI | 10.1016/j.jacc.2015.04.062 |
| Alternate Journal | J. Am. Coll. Cardiol. |
| PubMed ID | 26160626 |
| PubMed Central ID | PMC4499114 |
| Grant List | HHSN268200800007C / HL / NHLBI NIH HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States R01 HL116747 / HL / NHLBI NIH HHS / United States |