title: Meta-Analysis of Prognostic Implications of Exercise-Induced Ventricular Premature Complexes in the General Population.
abstract: Ventricular premature complexes (VPCs) during stress testing in the general population are commonly seen in clinical practice, but their prognostic value is not well understood. A comprehensive literature search of MEDLINE, Embase, and the Cochrane Library from January 1970 to May 2015 was conducted. Observational cohort studies on general populations evaluating the association between exercise-induced VPCs and all-cause or cardiovascular mortality were included in the analysis. Nine studies comprising 62,488 participants comparing clinical outcomes of patients with and without exercise-induced VPCs were included. The overall combined relative risks (RRs) for all-cause mortality and cardiovascular mortality in patients with exercise-induced VPCs were 1.41 (95% CI 1.23 to 1.61) and 1.86 (95% CI 1.51 to 2.30), respectively. In subgroup analysis, both frequent VPCs (RR 1.35, 95% CI 1.14 to 1.60) and infrequent VPCs (RR 1.57, 95% CI 1.13 to 2.18) were associated with an adverse outcome. VPCs during recovery were associated with an increased risk of death (RR 1.55, 95% CI 1.22 to 1.96). VPCs during exercise did not achieve statistical significance (RR 1.14, 95% CI 0.96 to 1.34), but only a few studies were included in the analysis. In conclusion, our meta-analysis suggests that exercise-induced VPCs in the general population significantly increase the risk of total mortality and cardiovascular mortality. Our study calls for further studies to assess the prognostic significance of exercise-induced VPCs and the utility of efforts to reduce the VPC burden to improve the clinical outcome.
authors.affiliation: Division of Cardiovascular Health and Disease, Department of Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Joonseok
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Medicine, Beaumont Hospital, Royal Oak, Michigan.
authors.forename: Minkyung
authors.initials: M
authors.lastname: Kwon
authors.affiliation: Department of Medicine, Michigan State University, East Lansing, Michigan.
authors.forename: Jinsoo
authors.initials: J
authors.lastname: Chang
authors.affiliation: Division of Cardiovascular Health and Disease, Department of Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: David
authors.initials: D
authors.lastname: Harris
authors.affiliation: Division of Cardiovascular Health and Disease, Department of Medicine, University of Cincinnati, Cincinnati, Ohio.
authors.forename: Myron C
authors.initials: MC
authors.lastname: Gerson
authors.affiliation: Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, Korea.
authors.forename: Seung-Sik
authors.initials: SS
authors.lastname: Hwang
authors.affiliation: Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea. Electronic address: sw.oh@snu.ac.kr.
authors.forename: Seung-Won
authors.initials: SW
authors.lastname: Oh
mesh_terms: D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000209:etiology*; D019317:Evidence-Based Medicine; D005080:Exercise Test / Q000009:adverse effects*; D006801:Humans; D064887:Observational Studies as Topic; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D018879:Ventricular Premature Complexes / Q000150:complications / Q000209:etiology* / Q000401:mortality*