Medicine, University of California San Francisco, San Francisco, California, USA.
Division of Cardiology, Electrophysiology Section, University of California San Francisco, San Francisco, California, USA.
Heart. 2022 Jan;108(2):105-110. doi: 10.1136/heartjnl-2021-319473. Epub 2021 Sep 7.
A higher premature ventricular complex (PVC) frequency is associated with incident congestive heart failure (CHF) and death. While certain PVC characteristics may contribute to that risk, the current literature stems from patients in medical settings and is therefore prone to referral bias. This study aims to identify PVC characteristics associated with incident CHF in a community-based setting.
The Cardiovascular Health Study is a cohort of community-dwelling individuals who underwent prospective evaluation and follow-up. We analysed 24-hour Holter data to assess PVC characteristics and used multivariable logistic and Cox proportional hazards models to identify predictors of a left ventricular ejection fraction (LVEF) decline and incident CHF, respectively.
Of 871 analysed participants, 316 participants exhibited at least 10 PVCs during the 24-hour recording. For participants with PVCs, the average age was 72±5 years, 41% were women and 93% were white. Over a median follow-up of 11 years, 34% developed CHF. After adjusting for demographics, cardiovascular comorbidities, antiarrhythmic drug use and PVC frequency, a greater heterogeneity of the PVC coupling interval was associated with an increased risk of LVEF decline and incident CHF. Of note, neither PVC duration nor coupling interval duration exhibited a statistically significant relationship with either outcome.
In this first community-based study to identify Holter-based features of PVCs that are associated with LVEF reduction and incident CHF, the fact that coupling interval heterogeneity was an independent risk factor suggests that the mechanism of PVC generation may influence the risk of heart failure.
较高的室性期前收缩（PVC）频率与充血性心力衰竭（CHF）和死亡的发生有关。虽然某些 PVC 特征可能会增加这种风险，但目前的文献来源于医疗环境中的患者，因此容易受到转诊偏倚的影响。本研究旨在确定社区环境中与 CHF 发生相关的 PVC 特征。
心血管健康研究是一个社区居住者队列，他们接受了前瞻性评估和随访。我们分析了 24 小时动态心电图数据，以评估 PVC 特征，并使用多变量逻辑和 Cox 比例风险模型分别确定左心室射血分数（LVEF）下降和 CHF 发生的预测因素。
在分析的 871 名参与者中，有 316 名参与者在 24 小时记录中至少出现 10 次 PVC。对于有 PVC 的参与者，平均年龄为 72±5 岁，41%为女性，93%为白人。在中位数为 11 年的随访期间，34%的参与者发生 CHF。在调整了人口统计学、心血管合并症、抗心律失常药物使用和 PVC 频率后，PVC 耦合间隔的更大异质性与 LVEF 下降和 CHF 发生的风险增加相关。值得注意的是，PVC 持续时间和耦合间隔持续时间均与这两种结果均无统计学显著关系。
在这项首次以社区为基础的研究中，我们确定了与 LVEF 降低和 CHF 发生相关的 Holter 基于 PVC 特征，即耦合间隔异质性是一个独立的危险因素，这表明 PVC 产生的机制可能会影响心力衰竭的风险。
