重新审视运动诱发的室性早搏作为无症状患者死亡率的预后因素：一项系统评价和荟萃分析。
Revisiting exercise-induced premature ventricular complexes as a prognostic factor for mortality in asymptomatic patients: A systematic review and meta-analysis.
作者信息
Iqbal Mohammad, Putra Iwan Cahyo Santosa, Kamarullah William, Pranata Raymond, Achmad Chaerul, Karwiky Giky, Pramudyo Miftah, Goenawan Hanna, Akbar Mohammad Rizki, Kartasasmita Arief Sjamsulaksan, Kim Young Hoon
机构信息
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Padjadjaran, Bandung, Indonesia.
Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, South Korea.
出版信息
Front Cardiovasc Med. 2022 Sep 29;9:949694. doi: 10.3389/fcvm.2022.949694. eCollection 2022.
BACKGROUND
Recent investigations suggest that premature ventricular complexes (PVCs) during an exercise test are associated with an elevated risk of mortality in asymptomatic individuals. However, given the small number of studies included, the association between these two entities in the asymptomatic population remains obscure. Our aim was to evaluate this matter.
METHODS
A comprehensive literature search was conducted utilizing several online databases up to April 2022. The study comprised cohort studies examining the relationship between exercise-induced premature ventricular complexes (EI-PVCs) and all-cause mortality (ACM) as well as cardiovascular mortality (CVM) in asymptomatic populations. To provide diagnostic values across the statistically significant parameters, we additionally calculated sensitivity, specificity, and area under the curve (AUC).
RESULTS
A total of 13 studies consisting of 82,161 patients with a mean age of 49.3 years were included. EI-PVCs were linked to an increased risk of ACM (risk ratio (RR) = 1.30 (95% confidence interval (CI) = 1.18-1.42); < 0.001; = 59.6%, -heterogeneity < 0.001) and CVM (RR = 1.67 (95% CI = 1.40-1.99); < 0.001; = 7.5%, -heterogeneity = 0.373). Subgroup analysis based on the frequency of PVCs revealed that frequent PVCs were similarly related to a higher risk of ACM and CVM, but not infrequent PVCs. Moreover, diagnostic test accuracy meta-analysis showed that recovery phase EI-PVCs have a higher overall specificity than exercise phase EI-PVCs regarding our outcomes of interest.
CONCLUSION
EI-PVCs are correlated with a higher risk of ACM and CVM. When compared to the exercise phase, the specificity of PVCs generated during the recovery period in predicting interest outcomes is higher. As a result, we propose that the exercise ECG be utilized on a regular basis in middle-aged asymptomatic individuals to measure the frequency of PVCs and stratify the risk of mortality.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=328852], identifier [CRD42022328852].
背景
近期研究表明，运动试验期间的室性早搏（PVC）与无症状个体的死亡风险升高有关。然而，鉴于纳入研究数量较少，无症状人群中这两者之间的关联仍不明确。我们的目的是评估此事。
方法
截至2022年4月，利用多个在线数据库进行了全面的文献检索。该研究包括队列研究，考察运动诱发的室性早搏（EI-PVC）与无症状人群的全因死亡率（ACM）以及心血管死亡率（CVM）之间的关系。为了给出具有统计学意义参数的诊断价值，我们还计算了敏感性、特异性和曲线下面积（AUC）。
结果
共纳入13项研究，涉及82161例患者，平均年龄49.3岁。EI-PVC与ACM风险增加相关（风险比（RR）=1.30（95%置信区间（CI）=1.18 - 1.42）；P<0.001；I² = 59.6%，异质性P<0.001）以及CVM（RR = 1.67（95%CI = 1.40 - 1.99）；P<0.001；I² = 7.5%，异质性P = 0.373）。基于PVC频率的亚组分析显示，频发PVC同样与较高的ACM和CVM风险相关，但偶发PVC并非如此。此外，诊断试验准确性的荟萃分析表明，就我们感兴趣的结局而言，恢复期EI-PVC的总体特异性高于运动期EI-PVC。
结论
EI-PVC与较高的ACM和CVM风险相关。与运动期相比，恢复期产生的PVC在预测感兴趣结局时的特异性更高。因此，我们建议在中年无症状个体中定期使用运动心电图来测量PVC频率并分层死亡风险。
系统评价注册
[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=328852]，标识符[CRD42022328852]
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