Ventricular Ectopy as a Predictor of Heart Failure and Death

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. The goal of this s...

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Vydané v:	Journal of the American College of Cardiology Ročník 66; číslo 2; s. 101
Hlavní autori:	Dukes, Jonathan W, Dewland, Thomas A, Vittinghoff, Eric, Mandyam, Mala C, Heckbert, Susan R, Siscovick, David S, Stein, Phyllis K, Psaty, Bruce M, Sotoodehnia, Nona, Gottdiener, John S, Marcus, Gregory M
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	United States 14.07.2015
Predmet:	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 mortality arrhythmia premature ventricular contractions
ISSN:	1558-3597, 1558-3597
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Abstract	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. 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. 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. 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%). 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.
AbstractList	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.BACKGROUNDStudies 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.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.OBJECTIVESThe 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.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.METHODSWe 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.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%).RESULTSThose 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%).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.CONCLUSIONSIn 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. 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. 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. 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. 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%). 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.
Author	Siscovick, David S Psaty, Bruce M Dewland, Thomas A Marcus, Gregory M Dukes, Jonathan W Vittinghoff, Eric Sotoodehnia, Nona Heckbert, Susan R Mandyam, Mala C Gottdiener, John S Stein, Phyllis K
Author_xml	– sequence: 1 givenname: Jonathan W surname: Dukes fullname: Dukes, Jonathan W organization: Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California – sequence: 2 givenname: Thomas A surname: Dewland fullname: Dewland, Thomas A organization: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon – sequence: 3 givenname: Eric surname: Vittinghoff fullname: Vittinghoff, Eric organization: Department of Epidemiology and Biostatistics, University of California, San Francisco, California – sequence: 4 givenname: Mala C surname: Mandyam fullname: Mandyam, Mala C organization: Department of Medicine, Stanford University School of Medicine, Stanford, California – sequence: 5 givenname: Susan R surname: Heckbert fullname: Heckbert, Susan R organization: Cardiovascular Health Research Unit, University of Washington, Seattle, Washington – sequence: 6 givenname: David S surname: Siscovick fullname: Siscovick, David S organization: Cardiovascular Health Research Unit, University of Washington, Seattle, Washington; New York Academy of Medicine, New York, New York – sequence: 7 givenname: Phyllis K surname: Stein fullname: Stein, Phyllis K organization: Cardiovascular Division, Washington University School of Medicine, Seattle, Washington – sequence: 8 givenname: Bruce M surname: Psaty fullname: Psaty, Bruce M organization: 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 – sequence: 9 givenname: Nona surname: Sotoodehnia fullname: Sotoodehnia, Nona organization: Cardiovascular Health Research Unit, University of Washington, Seattle, Washington; Division of Cardiology, University of Washington, Seattle, Washington – sequence: 10 givenname: John S surname: Gottdiener fullname: Gottdiener, John S organization: Division of Cardiology, University of Maryland Medical Center, Baltimore, Maryland – sequence: 11 givenname: Gregory M surname: Marcus fullname: Marcus, Gregory M email: marcusg@medicine.ucsf.edu organization: Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California. Electronic address: marcusg@medicine.ucsf.edu
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/26160626$$D View this record in MEDLINE/PubMed
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Copyright	Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Keywords	mortality arrhythmia premature ventricular contractions
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References	26157080 - BMJ. 2015 Jul 07;351:h3674. doi: 10.1136/bmj.h3674. 26160627 - J Am Coll Cardiol. 2015 Jul 14;66(2):110-2. doi: 10.1016/j.jacc.2015.05.031.
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Snippet	Studies of patients presenting for catheter ablation suggest that premature ventricular contractions (PVCs) are a modifiable risk factor for congestive heart...
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SubjectTerms	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
Title	Ventricular Ectopy as a Predictor of Heart Failure and Death
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