TY - JOUR
T1 - Exercise-Induced Ventricular Ectopy and Cardiovascular Mortality in Asymptomatic Individuals
AU - Refaat, Marwan M.
AU - Gharios, Charbel
AU - Moorthy, M. Vinayaga
AU - Abdulhai, Farah
AU - Blumenthal, Roger S.
AU - Jaffa, Miran A.
AU - Mora, Samia
N1 - Funding Information:
Dr Gharios was supported by the Fogarty International Center and Office of Dietary Supplements of the National Institutes of Health under Award Number D43 TW009118 via the Scholars in HeAlth Research Program (SHARP) at the American University of Beirut. Dr Mora was supported by NHLBI K24HL 136852. The funders had no role in the design or conduct of the study; in the collection, analysis, and interpretation of the data; and in the preparation, review, or approval of the manuscript. Dr Mora has served as a consultant to Pfizer and Quest Diagnostics for work unrelated to the current study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/12/7
Y1 - 2021/12/7
N2 - Background: The prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear. Objectives: This study sought to investigate whether high-grade PVCs during stress testing predict mortality in asymptomatic individuals. Methods: A cohort of 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 per minute), 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 (hazard ratio [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-segment 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. Conclusions: High-grade PVCs occurring during recovery were associated with long-term risk of cardiovascular mortality in asymptomatic individuals, whereas PVCs occurring only during exercise were not associated with increased risk.
AB - Background: The prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear. Objectives: This study sought to investigate whether high-grade PVCs during stress testing predict mortality in asymptomatic individuals. Methods: A cohort of 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 per minute), 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 (hazard ratio [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-segment 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. Conclusions: High-grade PVCs occurring during recovery were associated with long-term risk of cardiovascular mortality in asymptomatic individuals, whereas PVCs occurring only during exercise were not associated with increased risk.
KW - cardiac arrhythmia
KW - cardiovascular disease
KW - heart disease
KW - premature ventricular contraction
KW - stress test
KW - ventricular ectopy
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U2 - 10.1016/j.jacc.2021.09.1366
DO - 10.1016/j.jacc.2021.09.1366
M3 - Article
C2 - 34857087
AN - SCOPUS:85119273865
SN - 0735-1097
VL - 78
SP - 2267
EP - 2277
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 23
ER -