Ephrem Georges, Levine Michael, Friedmann Patricia, Schweitzer Paul
Department of Medicine, Beth Israel Medical Center, New York, NY 10003, USA.
Ann Noninvasive Electrocardiol. 2013 Mar;18(2):118-25. doi: 10.1111/anec.12010. Epub 2012 Nov 22.
Multiform premature ventricular complexes (PVCs) are associated with an adverse prognosis in patients with structural heart disease. Very frequent PVCs are associated with ventricular dysfunction. Our hypothesis is that multiform PVCs confer an adverse prognosis in the general population.
We performed a retrospective cohort study of patients ≥18 years old referred to our institution for 24-hour ambulatory Holter monitoring between July 1, 2008 and December 31, 2009. Holters without PVCs or with more frequent ectopy (couplets, triplets, or nonsustained ventricular tachycardia) were excluded. Clinical and adverse event (AE) data ("major adverse cardiovascular event" or new/worsening heart failure) were gathered from chart review. Data was analyzed by PVC frequency (rare, occasional, or frequent) and pattern (uniform or multiform).
A total of 222 patients (43% male, mean age: 55 ± 16 years) were evaluated (median follow-up 2.3 years [IQR: 2.0-2.6]). Median frequency was 2 PVCs per hour (IQR: 1-13). Multiform PVCs were noted in 48%. Patients with multiform PVCs were older, and had a higher prevalence of comorbidities. Thirty-nine AE were noted. Patients with an AE were younger, had a higher prevalence of HTN, diabetes, CAD, CHF, and previous MI. The multiform group had a higher incidence of AE (28%) compared to the uniform group (8%) (P < 0.001). Increasing PVC frequency was associated with a higher incidence of AE (8% vs 24% vs 35%, respectively). In Cox regression analyses, the multiform pattern but not frequency predicted AE.
Multiform PVCs were associated with a 4-fold increase in AE in patients referred for ambulatory Holter monitoring.
多形性室性早搏（PVCs）与结构性心脏病患者的不良预后相关。频发PVCs与心室功能障碍有关。我们的假设是多形性PVCs在普通人群中预示着不良预后。
我们对2008年7月1日至2009年12月31日期间因24小时动态心电图监测转诊至我院的18岁及以上患者进行了一项回顾性队列研究。排除无PVCs或有更频繁异位心律（成对、三联律或非持续性室性心动过速）的动态心电图。通过查阅病历收集临床和不良事件（AE）数据（“主要不良心血管事件”或新发/加重的心力衰竭）。数据按PVC频率（罕见、偶发或频发）和形态（单形或多形）进行分析。
共评估了222例患者（43%为男性，平均年龄：55±16岁）（中位随访2.3年[四分位间距：2.0 - 2.6]）。中位频率为每小时2次PVCs（四分位间距：1 - 13）。48%的患者有多形性PVCs。有多形性PVCs的患者年龄较大，合并症患病率较高。记录到39例AE。发生AE的患者年龄较小，高血压、糖尿病、冠心病、心力衰竭和既往心肌梗死的患病率较高。与单形组（8%）相比，多形组AE发生率更高（28%）（P < 0.001）。PVC频率增加与AE发生率升高相关（分别为8%、24%和35%）。在Cox回归分析中，多形形态而非频率可预测AE。
在因动态心电图监测转诊的患者中，多形性PVCs与AE增加4倍相关。
