Ventricular Ectopy as a Predictor of Heart Failure and Death

Jonathan W Dukes; Thomas A Dewland; Eric Vittinghoff; Mala C Mandyam; Susan R Heckbert; David S Siscovick; Phyllis K Stein; Bruce M Psaty; Nona Sotoodehnia; John S Gottdiener; Gregory M Marcus

doi:10.1016/j.jacc.2015.04.062

Ventricular Ectopy as a Predictor of Heart Failure and Death

J Am Coll Cardiol. 2015 Jul 14;66(2):101-9. doi: 10.1016/j.jacc.2015.04.062.

Authors

Affiliations

¹ Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California.
² Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
³ Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
⁴ Department of Medicine, Stanford University School of Medicine, Stanford, California.
⁵ Cardiovascular Health Research Unit, University of Washington, Seattle, Washington.
⁶ Cardiovascular Health Research Unit, University of Washington, Seattle, Washington; New York Academy of Medicine, New York, New York.
⁷ Cardiovascular Division, Washington University School of Medicine, Seattle, Washington.
⁸ Cardiovascular Health Research Unit, University of Washington, Seattle, Washington; Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington; Group Health Research Institute, Group Health Cooperative, Seattle, Washington.
⁹ Cardiovascular Health Research Unit, University of Washington, Seattle, Washington; Division of Cardiology, University of Washington, Seattle, Washington.
¹⁰ Division of Cardiology, University of Maryland Medical Center, Baltimore, Maryland.
¹¹ Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California. Electronic address: marcusg@medicine.ucsf.edu.

Abstract

Background: 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.

Objectives: 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.

Methods: 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.

Results: 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%).

Conclusions: 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.

Keywords: arrhythmia; mortality; premature ventricular contractions.

MeSH terms

Aged
Catheter Ablation
Echocardiography
Electrocardiography, Ambulatory
Female
Forecasting
Heart Failure / diagnosis*
Heart Failure / mortality
Humans
Male
Risk Factors
Stroke Volume
Ventricular Premature Complexes / complications*
Ventricular Premature Complexes / mortality

Abstract

MeSH terms

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