Rest premature ventricular contractions on routine ECG and prognosis in heart failure patients.
BACKGROUND
Premature ventricular contractions (PVC) at rest are frequently seen in heart failure (HF) patients but conflicting data exist regarding their importance for cardiovascular (CV) mortality. This study aims to evaluate the prognostic value of rest PVCs on an electrocardiogram (ECG) in patients with a history of clinical HF.


RESULTS
We considered 352 patients (64 + or - 11 years; 7 females) with a history of clinical HF undergoing treadmill testing for clinical reasons at the Veterans Affairs Palo Alto Health Care System (VAPAHCS) (1987-2007). Patients with rest PVCs were defined as having > or = 1 PVC on the ECG prior to testing (n = 29; 8%). During a median follow-up period of 6.2 years, there were 178 deaths of which 76 (42.6%) were due to CV causes. At baseline, compared to patients without rest PVCs, those with rest PVCs had a lower ejection fraction (EF) (30% vs 45%) and the prevalence of EF < or = 35% was higher (75% vs 41%). They were more likely to have smoked (76% vs 55%).The all-cause and CV mortality rates were significantly higher in the rest PVCs group (72% vs 49%, P = 0.01 and 45% vs 20%, P = 0.002; respectively). After adjusting for age, beta-blocker use, rest ECG findings, resting heart rate (HR), EF, maximal systolic blood pressure, peak HR, and exercise capacity, rest PVC was associated with a 5.5-fold increased risk of CV mortality (P = 0.004). Considering the presence of PVCs during exercise and/or recovery did not affect our results.


CONCLUSIONS
The presence of PVC on an ECG is a powerful predictor of CV mortality even after adjusting for confounding factors.
Division of Cardiovascular Medicine, Stanford University, School of Medicine, VA Palo Alto Health Care System, Cardiology 111C, 3801 Miranda Ave, Palo Alto, CA 94304, USA. vyvanle@gmail.com
Vy-Van
VV
Le
Teferi
T
Mitiku
David
D
Hadley
Jonathan
J
Myers
Victor F
VF
Froelicher
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001794:Blood Pressure; D002140:California / Q000453:epidemiology; D004562:Electrocardiography / Q000379:methods* / Q000706:statistics & numerical data*; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012146:Rest; D012907:Smoking / Q000453:epidemiology; D018879:Ventricular Premature Complexes / Q000453:epidemiology*; D014728:Veterans / Q000706:statistics & numerical data
D000319:Adrenergic beta-Antagonists