Chen Tien-En, Wang Chun-Cheng, Ho Hong-Chi, Lai Yi-Ching, Wu Hung-Bin, Lin Yen-Nien, Pai Pei-Ying
Department of Cardiology, China Medical University Hospital.
Medical College, China Medical University, Taichung, Taiwan.
Acta Cardiol Sin. 2023 Sep;39(5):687-694. doi: 10.6515/ACS.202309_39(5).20230119A.
Premature ventricular complex (PVC) without structural heart disease is mostly viewed as a benign arrhythmia. However, the high burden of PVC causes cardiomyopathy due to intraventricular dyssynchrony. The effects of ectopic contraction on left ventricular (LV) hemodynamics in the structurally normal heart are unclear.
To examine the effect of PVC burden on LV dimension, LV systolic function, and intraventricular blood flow, and to determine whether ectopic ventricular contraction affects LV hemodynamics.
Patients aged ≥ 18 years with PVC ≥ 5% on Holter recording were enrolled and divided into groups G1 (5-10%), G2 (10-20%), and G3 (≥ 20%). We excluded patients with structural heart diseases, pacemakers, and LV systolic dysfunction [LV ejection fraction (LVEF) < 50%]. Clinical characteristics and routine transthoracic echocardiography parameters were compared.
The end-systolic LV internal dimension increased according to the PVC burden from G1 to G3 (p = 0.001). LVEF was inversely associated with PVC burden from G1 to G3 (p = 0.002). The same pattern was seen for LV outflow tract (LVOT) maximal velocity (p = 0.005) and maximal pressure gradient (PG) (p = 0.005), LVOT velocity time integral (VTI) (p = 0.03) and LV stroke volume index (LVSI) (p = 0.008).
Systolic function and LV end-systolic dimension were inversely associated with PVC burden. Decreased LVOT flow velocity and PG were related to increased PVC burden. LVOT VTI and LVSI were smaller when the PVC burden exceeded 20%. These negative hemodynamic manifestations of idiopathic PVC were considerable even in structure normal hearts, hence the early elimination of PVC is strongly advised.
无结构性心脏病的室性早搏（PVC）大多被视为良性心律失常。然而，PVC的高负荷由于心室内不同步会导致心肌病。在结构正常的心脏中，异位收缩对左心室（LV）血流动力学的影响尚不清楚。
研究PVC负荷对LV尺寸、LV收缩功能和心室内血流的影响，并确定异位心室收缩是否影响LV血流动力学。
纳入年龄≥18岁、动态心电图记录中PVC≥5%的患者，并分为G1组（5 - 10%）、G2组（10 - 20%）和G3组（≥20%）。我们排除了患有结构性心脏病、起搏器和LV收缩功能障碍[左心室射血分数（LVEF）<50%]的患者。比较临床特征和常规经胸超声心动图参数。
从G1到G3，LV收缩末期内径随PVC负荷增加而增大（p = 0.001）。从G1到G3，LVEF与PVC负荷呈负相关（p = 0.002）。LV流出道（LVOT）最大速度（p = 0.005）和最大压力阶差（PG）（p = 0.005）、LVOT速度时间积分（VTI）（p = 0.03）和LV每搏量指数（LVSI）（p = 0.008）也呈现相同模式。
收缩功能和LV收缩末期内径与PVC负荷呈负相关。LVOT流速和PG降低与PVC负荷增加有关。当PVC负荷超过20%时，LVOT VTI和LVSI较小。即使在结构正常的心脏中，特发性PVC的这些负面血流动力学表现也很显著，因此强烈建议早期消除PVC。
