Aviles-Rosales Jorge, Ilarraza-Lomeli Hermes, Garcia-Saldivia Marianna, Rojano-Castillo Jessica, Rius-Suarez Maria-Dolores, Nunez-Urquiza Juan-Pablo, Iturralde Pedro
Cardiac Rehabilitation Department, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico.
Cardiac Rehabilitation Department, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico.
Arch Cardiol Mex. 2018 Dec;88(5):354-359. doi: 10.1016/j.acmx.2017.07.004. Epub 2017 Aug 14.
Exercise-induced premature ventricular complexes (EiPVCs) are often considered as benign arrhythmias, although they are associated with a high risk of all-cause death in the general healthy population. However, an intermediate pathophysiological process remains unclear, particularly in patients with known cardiovascular disease. The aim of this study was to find an association between EiPVCs, the occurrence of life-threatening ventricular arrhythmias (LACO), and all-cause mortality in patients with cardiovascular disease.
This was an observational study of a cohort of patients with coronary artery disease (CAD) or idiopathic cardiomyopathy (ICM). Stress testing was performed as a part of the routine cardiovascular evaluation. The occurrence of EiPVCs was evaluated during exercise testing (ET). At follow-up, long-term occurrence of LACO was evaluated. A bivariate and multivariate analysis was performed.
Out of the total of 1442 patients analysed, 700 (49%) had EiPVCs. During 14 years of following-up after ET, 106 LACO outcomes were observed. Long-term all-cause mortality was 4% (n=61). A bivariate analysis showed that patients with EiPVCs had an increased risk for LACO (RR=2.81, 95% CI; 1.9-4.3, P<.001), and for mortality (RR=2.1, CI 1.2-3.4, P<.01). Occurrence of LACO was also associated with a higher mortality risk (RR=5.7, 95% CI; 3.4-9.4, P<.001). After a post hoc analysis, LACO remained as a highly predictive variable for mortality.
Patients with EiPVCs have a high risk of LACO and all-cause mortality. The presence of LACO could be an intermediate stage between EiPVCs and mortality in subjects with cardiovascular disease.
运动诱发的室性早搏（EiPVCs）通常被认为是良性心律失常，尽管在一般健康人群中它们与全因死亡的高风险相关。然而，中间的病理生理过程仍不清楚，尤其是在已知患有心血管疾病的患者中。本研究的目的是在患有心血管疾病的患者中寻找EiPVCs、危及生命的室性心律失常（LACO）的发生与全因死亡率之间的关联。
这是一项对冠心病（CAD）或特发性心肌病（ICM）患者队列的观察性研究。压力测试作为常规心血管评估的一部分进行。在运动测试（ET）期间评估EiPVCs的发生情况。在随访期间，评估LACO的长期发生情况。进行了双变量和多变量分析。
在总共分析的1442名患者中，700名（49%）有EiPVCs。在ET后的14年随访期间，观察到106例LACO结果。长期全因死亡率为4%（n = 61）。双变量分析显示，有EiPVCs的患者发生LACO的风险增加（RR = 2.81，95%CI；1.9 - 4.3，P <.001），以及死亡风险增加（RR = 2.1，CI 1.2 - 3.4，P <.01）。LACO的发生也与更高的死亡风险相关（RR = 5.7，95%CI；3.4 - 9.4，P <.001）。经过事后分析，LACO仍然是死亡率的高度预测变量。
有EiPVCs的患者发生LACO和全因死亡的风险很高。LACO的存在可能是患有心血管疾病的受试者中EiPVCs与死亡之间的中间阶段。
