Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon; Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine, Beirut, Lebanon.
Department of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon; Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
J Am Coll Cardiol. 2021 Dec 7;78(23):2267-2277. doi: 10.1016/j.jacc.2021.09.1366.
The prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear.
This study sought to investigate whether high-grade PVCs during stress testing predict mortality in asymptomatic individuals.
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.
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.
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.
运动引起的室性早搏（PVCs）在无症状个体中的预后尚不清楚。
本研究旨在探讨应激试验中出现的高级别 PVC 是否可预测无症状个体的死亡率。
一项纳入了 5486 名无症状个体的队列研究，参与者在基线时接受了访谈、体格检查、血液检查，并进行了布鲁斯方案平板运动试验。校正后的 Cox 生存模型评估了运动诱导的高级别 PVC（定义为每分钟≥10 次、多灶性、R-on-T 型或≥2 个 PVC 连续出现）与全因和心血管死亡率之间的关系。
平均基线年龄为 45.4 ± 10.8 岁，42%为女性。在平均 20.2 ± 3.9 年的随访期间，共发生 840 例死亡，其中 311 例为心血管死亡。1.8%的个体在运动时、2.4%的个体在恢复期时、0.8%的个体在运动和恢复期时出现高级别 PVC。在校正年龄、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，恢复期的高级别 PVC 与心血管死亡率相关（危险比 [HR]：1.82；95%可信区间：1.19-2.79；P=0.006），在进一步校正运动时间、心率恢复、达到目标心率和 ST 段压低后仍具有统计学意义（HR：1.68；95%可信区间：1.09-2.60；P=0.020）。各临床亚组的结果相似。仅在运动阶段出现的高级别 PVC 与风险增加无关。恢复期出现的高级别 PVC 并不能提高临床变量之外的 20 年心血管死亡率风险预测能力。
在无症状个体中，恢复期出现的高级别 PVC 与长期心血管死亡率风险相关，而仅在运动时出现的 PVC 与风险增加无关。
