title: Prognostic significance of PVCs and resting heart rate.
abstract: BACKGROUND
  We sought to evaluate the prognostic significance of premature ventricular contractions (PVCs) on a routine electrocardiogram (ECG) and to evaluate the relationship between heart rate and PVCs.
  
  
  METHODS
  Computerized 12-lead ECGs of 45,402 veterans were analyzed. Vital status was available through the California Health Department Service.
  
  
  RESULTS
  There were 1731 patients with PVCs (3.8%). Compared to patients without PVCs, those with PVCs had significantly higher all-cause (39% vs 22%, P < 0.001) and cardiovascular mortality (20% vs 8%, P < 0.001). PVCs remain a significant predictor even after adjustment for age and other ECG abnormalities. The presence of multiple PVCs or complex morphologies did not add significant additional prognostic information. Those patients with PVCs had a significantly higher heart rate than those without PVCs (mean +/- SD: 78.6 +/- 15 vs 73.5 +/- 16 bpm, P < 0.001). When patients were divided into groups by heart rate (<60, 60-79, 80-99 and >100 bpm) and by the presence or absence of PVCs, mortality increased progressively with heart rate and doubled with the presence of PVCs. Using regression analysis, heart rate was demonstrated to be an independent and significant predictor of PVCs.
  
  
  CONCLUSIONS
  PVCs on a resting ECG are a significant and independent predictor of all-cause and cardiovascular mortality. Increased heart rate predicts mortality in patients with and without PVCs and the combination dramatically increases mortality. These findings together with the demonstrated independent association of heart rate with PVCs suggest that a hyperadrenergic state is present in patients with PVCs and that it likely contributes to their adverse prognosis.
authors.affiliation: Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Engel
authors.forename: Shaun
authors.initials: S
authors.lastname: Cho
authors.forename: Afshin
authors.initials: A
authors.lastname: Ghayoumi
authors.forename: Takuya
authors.initials: T
authors.lastname: Yamazaki
authors.forename: Sung
authors.initials: S
authors.lastname: Chun
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
authors.forename: Victor F
authors.initials: VF
authors.lastname: Froelicher
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012044:Regression Analysis; D018570:Risk Assessment; D018879:Ventricular Premature Complexes / Q000503:physiopathology*; D014728:Veterans