Exercise-Induced Ventricular Ectopy and Cardiovascular Mortality in Asymptomatic Individuals

The prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear. This study sought to investigate whether high-grade PVCs during stress testing predict mortality in asymptomatic individuals. A cohort of 5,486 asymptomatic individuals who took part i...

Full description

Saved in:
Bibliographic Details
Published in:Journal of the American College of Cardiology Vol. 78; no. 23; p. 2267
Main Authors: Refaat, Marwan M, Gharios, Charbel, Moorthy, M Vinayaga, Abdulhai, Farah, Blumenthal, Roger S, Jaffa, Miran A, Mora, Samia
Format: Journal Article
Language:English
Published: United States 07.12.2021
Subjects:
Exercise - physiology
Exercise Test - adverse effects
Female
Follow-Up Studies
Heart Rate - physiology
Humans
Male
Middle Aged
North America - epidemiology
Prognosis
Prospective Studies
Risk Assessment - methods
Survival Rate - trends
Ventricular Premature Complexes - etiology
Ventricular Premature Complexes - mortality
Ventricular Premature Complexes - physiopathology
North America
premature ventricular contraction
stress test
cardiovascular disease
ventricular ectopy
cardiac arrhythmia
heart disease
ISSN:1558-3597, 1558-3597
Online Access:Get more information
Tags: Add Tag
No Tags, Be the first to tag this record!
Abstract The prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear. This study sought to investigate whether high-grade PVCs during stress testing predict mortality in asymptomatic individuals. 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. 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. 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.
AbstractList The prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear. This study sought to investigate whether high-grade PVCs during stress testing predict mortality in asymptomatic individuals. 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. 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. 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.
The prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear.BACKGROUNDThe prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear.This study sought to investigate whether high-grade PVCs during stress testing predict mortality in asymptomatic individuals.OBJECTIVESThis study sought to investigate whether high-grade PVCs during stress testing predict mortality in asymptomatic individuals.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.METHODSA 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.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.RESULTSMean 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.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.CONCLUSIONSHigh-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.
Author Jaffa, Miran A
Blumenthal, Roger S
Moorthy, M Vinayaga
Gharios, Charbel
Abdulhai, Farah
Mora, Samia
Refaat, Marwan M
Author_xml – sequence: 1
  givenname: Marwan M
  surname: Refaat
  fullname: Refaat, Marwan M
  organization: Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon; Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine, Beirut, Lebanon
– sequence: 2
  givenname: Charbel
  surname: Gharios
  fullname: Gharios, Charbel
  organization: Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon; Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
– sequence: 3
  givenname: M Vinayaga
  surname: Moorthy
  fullname: Moorthy, M Vinayaga
  organization: Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
– sequence: 4
  givenname: Farah
  surname: Abdulhai
  fullname: Abdulhai, Farah
  organization: Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
– sequence: 5
  givenname: Roger S
  surname: Blumenthal
  fullname: Blumenthal, Roger S
  organization: The Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland, USA
– sequence: 6
  givenname: Miran A
  surname: Jaffa
  fullname: Jaffa, Miran A
  email: ms148@aub.edu.lb
  organization: Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. Electronic address: ms148@aub.edu.lb
– sequence: 7
  givenname: Samia
  surname: Mora
  fullname: Mora, Samia
  email: smora@bwh.harvard.edu
  organization: Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Electronic address: smora@bwh.harvard.edu
BackLink https://www.ncbi.nlm.nih.gov/pubmed/34857087$$D View this record in MEDLINE/PubMed
BookMark eNpNkMtKxDAYhYOMOBd9AkG6dNOa9JImy2EYdUBxo-6k_E3-QobeTNLBvo3P4pNZmBFcnQPn48A5SzJruxYJuWY0YpTxu320B6WimMYsojJiCednZMGyTIRJJvPZPz8nS-f2lFIumLwg8yQVWU5FviAf2y-0yjgMd60eFOrgHVtvjRpqsMFW-a4fA2j1z_cGrDbdAdwxeu6sh9r4MTBtsHZj0_uuAW9UMBWZg9ED1O6SnFeT4NVJV-Ttfvu6eQyfXh52m_VTqDIW-1BInlKdcQaVACmVyjlgQmma5loAwwRkWWUV8FRK4FWuUJZpKSQmmIOoIF6R22Nvb7vPAZ0vGuMU1jW02A2uiDnlMp4Wywm9OaFD2aAuemsasGPxd0n8C7wKaR4
CitedBy_id crossref_primary_10_1016_j_medcli_2022_05_006
crossref_primary_10_1159_000529670
crossref_primary_10_3389_fcvm_2022_949694
crossref_primary_10_1038_s41598_022_14535_w
crossref_primary_10_1016_j_pcad_2022_10_011
crossref_primary_10_1016_j_ihj_2023_10_001
crossref_primary_10_1007_s00392_023_02195_3
crossref_primary_10_1136_openhrt_2024_003133
crossref_primary_10_3389_fped_2024_1373772
crossref_primary_10_1093_eurheartj_ehad491
crossref_primary_10_3390_jcm14030985
crossref_primary_10_1016_j_jacc_2022_01_004
crossref_primary_10_3390_jcm13051350
crossref_primary_10_1016_j_jacc_2021_09_1365
crossref_primary_10_1016_j_medcle_2022_05_027
crossref_primary_10_1161_CIRCULATIONAHA_124_068557
crossref_primary_10_3390_jcm13226735
crossref_primary_10_1161_CIRCULATIONAHA_123_064633
crossref_primary_10_3390_jcm14134637
crossref_primary_10_1038_s41467_024_51791_y
crossref_primary_10_12677_acm_2025_1572094
crossref_primary_10_1093_ehjopen_oeac072
crossref_primary_10_1161_JAHA_122_027674
ContentType Journal Article
Copyright Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Copyright_xml – notice: Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
DBID CGR
CUY
CVF
ECM
EIF
NPM
7X8
DOI 10.1016/j.jacc.2021.09.1366
DatabaseName Medline
MEDLINE
MEDLINE (Ovid)
MEDLINE
MEDLINE
PubMed
MEDLINE - Academic
DatabaseTitle MEDLINE
Medline Complete
MEDLINE with Full Text
PubMed
MEDLINE (Ovid)
MEDLINE - Academic
DatabaseTitleList MEDLINE
MEDLINE - Academic
Database_xml – sequence: 1
  dbid: NPM
  name: PubMed
  url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
  sourceTypes: Index Database
– sequence: 2
  dbid: 7X8
  name: MEDLINE - Academic
  url: https://search.proquest.com/medline
  sourceTypes: Aggregation Database
DeliveryMethod no_fulltext_linktorsrc
Discipline Medicine
EISSN 1558-3597
ExternalDocumentID 34857087
Genre Multicenter Study
Journal Article
Research Support, N.I.H., Extramural
GeographicLocations North America
GeographicLocations_xml – name: North America
GrantInformation_xml – fundername: NHLBI NIH HHS
  grantid: K24 HL136852
– fundername: FIC NIH HHS
  grantid: D43 TW009118
GroupedDBID ---
--K
--M
.1-
.FO
.~1
0R~
0SF
18M
1B1
1P~
1~.
1~5
2WC
4.4
457
4G.
53G
5GY
5RE
5VS
6PF
7-5
71M
8P~
AABNK
AABVL
AACTN
AAEDT
AAEDW
AAFTH
AAIKJ
AAKUH
AALRI
AAOAW
AAQFI
AAQQT
AAXUO
ABBQC
ABFNM
ABFRF
ABLJU
ABMAC
ABMZM
ABOCM
ABVKL
ACGFO
ACGFS
ACIUM
ACJTP
ACPRK
ADBBV
ADEZE
ADVLN
AEFWE
AEKER
AENEX
AEVXI
AEXQZ
AFCTW
AFETI
AFRAH
AFRHN
AFTJW
AGYEJ
AHMBA
AITUG
AJOXV
AJRQY
AKRWK
ALMA_UNASSIGNED_HOLDINGS
AMFUW
AMRAJ
BAWUL
BLXMC
CGR
CS3
CUY
CVF
DIK
DU5
E3Z
EBS
ECM
EIF
EO8
EO9
EP2
EP3
F5P
FDB
FEDTE
FNPLU
G-Q
GBLVA
GX1
HVGLF
IHE
IXB
J1W
K-O
KQ8
L7B
MO0
N9A
NCXOZ
NPM
O-L
O9-
OA.
OAUVE
OK1
OL~
OZT
P-8
P-9
P2P
PC.
PQQKQ
Q38
ROL
RPZ
SCC
SDF
SDG
SDP
SES
SSZ
T5K
TR2
UNMZH
UV1
W8F
WH7
WOQ
WOW
YYM
YZZ
Z5R
7X8
ACVFH
ADCNI
AEUPX
AFPUW
AIGII
AKBMS
AKYEP
EFKBS
EFLBG
~HD
ID FETCH-LOGICAL-c512t-89640d561af8a99cc76ae300447d8a1e3a9bf5fa6499a6f7ce9b4b89e3e7a8fa2
IEDL.DBID 7X8
ISICitedReferencesCount 29
ISICitedReferencesURI http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000724528200003&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
ISSN 1558-3597
IngestDate Sun Sep 28 00:36:14 EDT 2025
Wed Feb 19 02:27:40 EST 2025
IsDoiOpenAccess false
IsOpenAccess true
IsPeerReviewed true
IsScholarly true
Issue 23
Keywords premature ventricular contraction
stress test
cardiovascular disease
ventricular ectopy
cardiac arrhythmia
heart disease
Language English
License Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c512t-89640d561af8a99cc76ae300447d8a1e3a9bf5fa6499a6f7ce9b4b89e3e7a8fa2
Notes ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
OpenAccessLink https://www.clinicalkey.com/#!/content/1-s2.0-S073510972107741X
PMID 34857087
PQID 2606927089
PQPubID 23479
ParticipantIDs proquest_miscellaneous_2606927089
pubmed_primary_34857087
PublicationCentury 2000
PublicationDate 2021-12-07
PublicationDateYYYYMMDD 2021-12-07
PublicationDate_xml – month: 12
  year: 2021
  text: 2021-12-07
  day: 07
PublicationDecade 2020
PublicationPlace United States
PublicationPlace_xml – name: United States
PublicationTitle Journal of the American College of Cardiology
PublicationTitleAlternate J Am Coll Cardiol
PublicationYear 2021
References 34857088 - J Am Coll Cardiol. 2021 Dec 7;78(23):2278-2280
References_xml – reference: 34857088 - J Am Coll Cardiol. 2021 Dec 7;78(23):2278-2280
SSID ssj0006819
Score 2.5094595
Snippet The prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear. This study sought to investigate whether...
The prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear.BACKGROUNDThe prognosis of exercise-induced...
SourceID proquest
pubmed
SourceType Aggregation Database
Index Database
StartPage 2267
SubjectTerms Exercise - physiology
Exercise Test - adverse effects
Female
Follow-Up Studies
Heart Rate - physiology
Humans
Male
Middle Aged
North America - epidemiology
Prognosis
Prospective Studies
Risk Assessment - methods
Survival Rate - trends
Ventricular Premature Complexes - etiology
Ventricular Premature Complexes - mortality
Ventricular Premature Complexes - physiopathology
Title Exercise-Induced Ventricular Ectopy and Cardiovascular Mortality in Asymptomatic Individuals
URI https://www.ncbi.nlm.nih.gov/pubmed/34857087
https://www.proquest.com/docview/2606927089
Volume 78
WOSCitedRecordID wos000724528200003&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D
hasFullText
inHoldings 1
isFullTextHit
isPrint
link http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1LS8QwEA7qinjx_VhfRPAabJs2j5MssosedtmDyh6EMk1SWMG22irsvzfJdl0ED4KX3lrayZD5MvP1-xC6ggA0MyYhMWdAYnsAIGBhK9EWTFCmEhGpwJtN8NFITCZy3Dbc6pZWudgT_UatS-V65NcWdzMZ8UDIm-qNONcoN11tLTRWUYdaKOMoXXyyVAtnwht72JIpCLXIeaE65PldL6CchGEUOp3TkLYyib9iTF9rBtv_fcsdtNWiTNybp8UuWjHFHtoYtnP0ffTcb52WiLPuUEbjJ9flnXpSKu6rpqxmGAqNb3_QVfHQg3UL3PG0wL169lo1pdd8xfffP3bVB-hx0H-4vSOtzwJRttw3REgWB9oCKcgFSKmUXTbjlLhirgWEhoLM8iQHZk9HwHKujMziTEhDDQeRQ3SI1oqyMMcIhyKjmdYqyZxOPxdZAnFiWO5dw-2TuuhyEbfU5rEbTkBhyo86XUaui47mwU-rueBGSmMnwy_4yR_uPkWbblE944SfoU5uv9uco3X12Uzr9wufIPY6Gg-_AHfAxm4
linkProvider ProQuest
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Exercise-Induced+Ventricular+Ectopy+and+Cardiovascular+Mortality+in+Asymptomatic+Individuals&rft.jtitle=Journal+of+the+American+College+of+Cardiology&rft.au=Refaat%2C+Marwan+M&rft.au=Gharios%2C+Charbel&rft.au=Moorthy%2C+M+Vinayaga&rft.au=Abdulhai%2C+Farah&rft.date=2021-12-07&rft.issn=1558-3597&rft.eissn=1558-3597&rft.volume=78&rft.issue=23&rft.spage=2267&rft_id=info:doi/10.1016%2Fj.jacc.2021.09.1366&rft.externalDBID=NO_FULL_TEXT
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1558-3597&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1558-3597&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1558-3597&client=summon