Exercise-Induced Ventricular Ectopy and Cardiovascular Mortality in Asymptomatic Individuals,Journal of the American College of Cardiology

当前位置： X-MOL 学术 › J. Am. Coll. Cardiol. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Exercise-Induced Ventricular Ectopy and Cardiovascular Mortality in Asymptomatic Individuals
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2021-11-29 , DOI: 10.1016/j.jacc.2021.09.1366
Marwan M Refaat ₁ , Charbel Gharios ₂ , M Vinayaga Moorthy ₃ , Farah Abdulhai ₄ , Roger S Blumenthal ₅ , Miran A Jaffa ₆ , Samia Mora ₃

Affiliation

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.

中文翻译：

无症状个体的运动诱发的心室异位和心血管死亡率

背景

无症状个体中运动诱发的室性早搏 (PVC) 的预后尚不清楚。

目标

本研究旨在调查压力测试期间的高级别 PVC 是否能预测无症状个体的死亡率。

方法

参加脂质研究诊所前瞻性队列的 5,486 名无症状个体进行了基线访谈、体格检查、血液检查，并接受了布鲁斯协议跑步机测试。调整后的 Cox 生存模型评估了运动诱发的高级别 PVC（定义为频繁（每分钟 10 次以上）、多灶性、R-on-T 型或连续 2 次以上 PVC）与全因和心血管的关联死亡。

结果

平均基线年龄为 45.4 ± 10.8 岁；42% 是女性。在平均 20.2 ± 3.9 年的随访期间，发生了 840 例死亡，包括 311 例心血管死亡。1.8% 的人在运动期间发生高级别 PVC，2.4% 在恢复期间发生，0.8% 在这两者期间发生。在调整年龄、性别、糖尿病、高血压、血脂、吸烟、体重指数和早发冠心病家族史后，恢复期间的高级别 PVC 与心血管死亡率相关（风险比 [HR]：1.82；95% CI ：1.19-2.79；P = 0.006），在进一步调整运动持续时间、心率恢复、达到目标心率和 ST 段压低后仍然显着（HR：1.68；95% CI：1.09-2.60；P = 0.020）。临床亚组的结果相似。运动阶段发生的高级别 PVC 与风险增加无关。恢复期 PVC 并未改善临床变量以外的 20 年心血管死亡风险歧视。