Van Chien Do, Kien Luyen Trung
Department of Cardiovascular Intensive Care Unit, 108 Central Military Hospital, Hanoi, Vietnam.
Department of Acute Diseases and Emergency, 108 Central Military Hospital, Hanoi, Vietnam.
BMC Cardiovasc Disord. 2025 Sep 26;25(1):677. doi: 10.1186/s12872-025-05154-0.
This study aimed to investigate the prevalence, characteristics, and associated clinical factors of arrhythmias-particularly atrial fibrillation (AF) and high-grade premature ventricular contractions (PVCs)-as detected by 24-hour Holter ECG monitoring in hospitalized elderly patients with diagnosed heart failure with ejection fraction ≤ 50%.
A cross-sectional study was conducted between May 2023 to March 2024 at the Cardiovascular Institute, 108 Central Military Hospital, Hanoi, Vietnam. A total of 72 hospitalized patients aged ≥ 65 years with confirmed heart failure (LVEF < 50%) were enrolled. Clinical characteristics, laboratory data, echocardiographic parameters, and 24-hour Holter monitoring results were collected. Multivariable logistic regression with stepwise forward selection (p-entry < 0.2) was used to identify predictors of AF and high-grade PVCs (Lown grade III-V).
The mean age was 73.7 ± 8.9 years, and 66.7% were male. AF was detected in 19.4% of patients, while a high PVC burden was common, with a median (25th -75th ) of 1955 (54-38514) and 58.3% falling into Lown grades III-V. Multivariable analysis identified increased body mass index (OR = 1.71, 95% CI: 1.18-2.48, p = 0.005) and elevated systolic pulmonary artery pressure (sPAP) (OR = 1.06, 95% CI: 1.00-1.13, p = 0.049) as independent predictors of AF. For high-grade PVCs, significant predictors included elevated sPAP (OR = 1.06, 95% CI: 1.01-1.12, p = 0.024), lower creatinine (OR = 0.99, 95% CI: 0.98-1.00, p = 0.014).
AF and high-grade PVCs are common in hospitalized elderly patients with diagnosed heart failure and are associated with distinct clinical and laboratory parameters. Elevated sPAP was a shared predictor of both arrhythmias. These findings support the use of integrated echocardiographic and Holter monitoring for risk stratification and management in this population.
本研究旨在调查在确诊射血分数≤50%的住院老年心力衰竭患者中，通过24小时动态心电图监测检测到的心律失常——尤其是心房颤动（AF）和高级别室性早搏（PVCs）——的患病率、特征及相关临床因素。
于2023年5月至2024年3月在越南河内中央军事医院心血管研究所进行了一项横断面研究。共纳入72例年龄≥65岁、确诊心力衰竭（左心室射血分数<50%）的住院患者。收集临床特征、实验室数据、超声心动图参数及24小时动态心电图监测结果。采用逐步向前选择的多变量逻辑回归（进入概率<0.2）来确定AF和高级别PVCs（Lown分级III - V级）的预测因素。
平均年龄为73.7±8.9岁，男性占66.7%。19.4%的患者检测到AF，而高PVC负荷较为常见，中位数（第25 - 75百分位数）为1955（54 - 38514），58.3%属于Lown分级III - V级。多变量分析确定体重指数升高（OR = 1.71，95%置信区间：1.18 - 2.48，p = 0.005）和收缩期肺动脉压（sPAP）升高（OR = 1.06，95%置信区间：1.00 - 1.13，p = 0.049）是AF的独立预测因素。对于高级别PVCs，显著的预测因素包括sPAP升高（OR = 1.06，95%置信区间：1.01 - 1.12，p = 0.024）、肌酐降低（OR = 0.99，95%置信区间：0.98 - 1.00，p = 0.014）。
AF和高级别PVCs在确诊心力衰竭的住院老年患者中很常见，且与不同的临床和实验室参数相关。sPAP升高是两种心律失常的共同预测因素。这些发现支持在该人群中使用综合超声心动图和动态心电图监测进行风险分层和管理。
