title: Fatigue as Presenting Symptom and a High Burden of Premature Ventricular Contractions Are Independently Associated With Increased Ventricular Wall Stress in Patients With Normal Left Ventricular Function.
abstract: BACKGROUND
  High idiopathic premature ventricular contractions (PVC) burden has been associated with PVC-induced cardiomyopathy. Patients may be symptomatic before left ventricular (LV) dysfunction develops. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and circumferential end-systolic wall stress (cESS) on echocardiography are markers for increased ventricular wall stress. This study aimed to evaluate the relation between presenting symptoms, PVC burden, and increased ventricular wall stress in patients with frequent PVCs and preserved LV function.
  
  
  RESULTS
  Eighty-three patients (41 men; 49±15 years) with idiopathic PVCs and normal LV function referred for PVC ablation were included. Type of symptoms (palpitations, fatigue, and [near-]syncope), PVC burden on 24-hour Holter, NT-proBNP levels, and cESS on echocardiography were assessed before and 3 months after ablation. Sustained successful ablation was defined as ≥80% PVC burden reduction during follow-up. Patients were symptomatic for 24 months (Q1-Q3, 16-60); 73% reported palpitations, 47% fatigue, and 30% (near-)syncope. Baseline PVC burden was 23±13%, median NT-proBNP 92 pg/mL (Q1-Q3 50-156), and cESS 143±35 kdyne/cm(2). Fatigue was associated with higher baseline NT-proBNP and cESS (P<0.001, P=0.011, respectively). After sustained successful ablation, achieved in 81%, NT-proBNP and cESS decreased significantly (P<0.001 and P=0.036, respectively). Fatigue was independently associated with a significantly larger reduction in NT-proBNP. In patients with nonsuccessful ablation, NT-proBNP and cESS remained unchanged.
  
  
  CONCLUSIONS
  In patients with frequent PVCs and preserved LV function, fatigue was associated with higher baseline NT-proBNP and cESS, and with a significantly larger reduction in NT-proBNP after sustained successful ablation. These findings support a link between fatigue and PVC-induced increased ventricular wall stress, despite preserved LV function.
authors.affiliation: From the Departments of Cardiology (C.F.B.v.H.v.T., S.R.D.P., M.d.R.S., D.A.P., M.J.S., A.P.W., K.Z.) and Clinical Epidemiology (O.M.D.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Carine F B
authors.initials: CF
authors.lastname: van Huls van Taxis
authors.affiliation: From the Departments of Cardiology (C.F.B.v.H.v.T., S.R.D.P., M.d.R.S., D.A.P., M.J.S., A.P.W., K.Z.) and Clinical Epidemiology (O.M.D.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Sebastiaan R D
authors.initials: SR
authors.lastname: Piers
authors.affiliation: From the Departments of Cardiology (C.F.B.v.H.v.T., S.R.D.P., M.d.R.S., D.A.P., M.J.S., A.P.W., K.Z.) and Clinical Epidemiology (O.M.D.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Marta
authors.initials: M
authors.lastname: de Riva Silva
authors.affiliation: From the Departments of Cardiology (C.F.B.v.H.v.T., S.R.D.P., M.d.R.S., D.A.P., M.J.S., A.P.W., K.Z.) and Clinical Epidemiology (O.M.D.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Olaf M
authors.initials: OM
authors.lastname: Dekkers
authors.affiliation: From the Departments of Cardiology (C.F.B.v.H.v.T., S.R.D.P., M.d.R.S., D.A.P., M.J.S., A.P.W., K.Z.) and Clinical Epidemiology (O.M.D.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Daniël A
authors.initials: DA
authors.lastname: Pijnappels
authors.affiliation: From the Departments of Cardiology (C.F.B.v.H.v.T., S.R.D.P., M.d.R.S., D.A.P., M.J.S., A.P.W., K.Z.) and Clinical Epidemiology (O.M.D.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.affiliation: From the Departments of Cardiology (C.F.B.v.H.v.T., S.R.D.P., M.d.R.S., D.A.P., M.J.S., A.P.W., K.Z.) and Clinical Epidemiology (O.M.D.), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Adrianus P
authors.initials: AP
authors.lastname: Wijnmaalen
authors.affiliation: From the Departments of Cardiology (C.F.B.v.H.v.T., S.R.D.P., M.d.R.S., D.A.P., M.J.S., A.P.W., K.Z.) and Clinical Epidemiology (O.M.D.), Leiden University Medical Center, Leiden, The Netherlands. K.Zeppenfeld@lumc.nl.
authors.forename: Katja
authors.initials: K
authors.lastname: Zeppenfeld
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D017115:Catheter Ablation; D018618:Echocardiography, Doppler, Color; D015716:Electrocardiography, Ambulatory; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D018879:Ventricular Premature Complexes / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: arrhythmias; catheter ablation; natriuretic peptide, brain