title: Ventricular Ectopy as a Predictor of Heart Failure and Death.
abstract: BACKGROUND
  Studies of patients presenting for catheter ablation suggest that premature ventricular contractions (PVCs) are a modifiable risk factor for congestive heart failure (CHF). The relationship among PVC frequency, incident CHF, and mortality in the general population remains unknown.
  
  
  OBJECTIVE
  The goal of this study was to determine whether PVC frequency ascertained using a 24-h Holter monitor is a predictor of a decrease in the left ventricular ejection fraction (LVEF), incident CHF, and death in a population-based cohort.
  
  
  METHODS
  We studied 1,139 Cardiovascular Health Study (CHS) participants who were randomly assigned to 24-h ambulatory electrocardiography (Holter) monitoring and who had a normal LVEF and no history of CHF. PVC frequency was quantified using Holter studies, and LVEF was measured from baseline and 5-year echocardiograms. Participants were followed for incident CHF and death.
  
  
  RESULTS
  Those in the upper quartile versus the lowest quartile of PVC frequency had a multivariable-adjusted, 3-fold greater odds of a 5-year decrease in LVEF (odds ratio [OR]: 3.10; 95% confidence interval [CI]: 1.42 to 6.77; p = 0.005), a 48% increased risk of incident CHF (HR: 1.48; 95% CI: 1.08 to 2.04; p = 0.02), and a 31% increased risk of death (HR: 1.31; 95% CI: 1.06 to 1.63; p = 0.01) during a median follow-up of >13 years. Similar statistically significant results were observed for PVCs analyzed as a continuous variable. The specificity for the 15-year risk of CHF exceeded 90% when PVCs included at least 0.7% of ventricular beats. The population-level risk for incident CHF attributed to PVCs was 8.1% (95% CI: 1.2% to 14.9%).
  
  
  CONCLUSIONS
  In a population-based sample, a higher frequency of PVCs was associated with a decrease in LVEF, an increase in incident CHF, and increased mortality. Because of the capacity to prevent PVCs through medical or ablation therapy, PVCs may represent a modifiable risk factor for CHF and death.
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Dukes
authors.affiliation: Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Dewland
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Mala C
authors.initials: MC
authors.lastname: Mandyam
authors.affiliation: Cardiovascular Health Research Unit, University of Washington, Seattle, Washington.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: Cardiovascular Health Research Unit, University of Washington, Seattle, Washington; New York Academy of Medicine, New York, New York.
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, Seattle, Washington.
authors.forename: Phyllis K
authors.initials: PK
authors.lastname: Stein
authors.affiliation: Cardiovascular Health Research Unit, University of Washington, Seattle, Washington; Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, Washington; Group Health Research Institute, Group Health Cooperative, Seattle, Washington.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.affiliation: Cardiovascular Health Research Unit, University of Washington, Seattle, Washington; Division of Cardiology, University of Washington, Seattle, Washington.
authors.forename: Nona
authors.initials: N
authors.lastname: Sotoodehnia
authors.affiliation: Division of Cardiology, University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: John S
authors.initials: JS
authors.lastname: Gottdiener
authors.affiliation: Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Francisco, California. Electronic address: marcusg@medicine.ucsf.edu.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Marcus
mesh_terms: D000368:Aged; D017115:Catheter Ablation; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005544:Forecasting; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D012307:Risk Factors; D013318:Stroke Volume; D018879:Ventricular Premature Complexes / Q000150:complications* / Q000401:mortality
keywords: arrhythmia; mortality; premature ventricular contractions