Exercise-Recovery PVCs and Abnormal Echo Raises Risk for CV Death

29/03/2022

The study covered in this summary was published on MedRxiv.org as a preprint and has not yet been peer reviewed.

Key Takeaways

Patients who experienced premature ventricular contractions (PVCs) during the recovery phase of exercise stress testing were more likely to have abnormal findings on echocardiography.
The risk for cardiovascular death was elevated in patients who had PVCs during recovery in addition to such echocardiographic abnormalities.

Why This Matters

The study supports previous research suggesting an association between PVCs during recovery and structural heart disease.
It might help clarify mechanisms underlying increased cardiovascular risk in patients who experience PVCs during the recovery phase of exercise testing.
The findings suggest that patients with stress-test recovery PVCs should be evaluated for structural heart disease by echocardiography, as echo findings associated with poor prognosis in this population were identified.

Study Design

The retrospective cohort study included 3106 adult patients at a single center in Sweden who performed a bicycle exercise stress test and underwent resting transthoracic echocardiography.
The number of PVCs experienced in the first 4 minutes of recovery from exercise was documented. Patients were categorized as either having recovery PVCs (defined as ≥1 PVC/minute) or not having such PVCs (defined as <1 PVC/minute).
The study evaluated effects on cardiovascular risk from such recovery PVCs and any associated echo abnormalities, including left ventricular dilatation or hypertrophy, reduced ejection fraction, elevated filling pressures, and signs of valvular disease.

Key Results

PVCs were observed during the recovery phase of exercise stress testing in 1327 patients (42.7%).
During an 8-year median follow-up, 219 patients (7.1%) died from cardiovascular causes. There were significantly more of these deaths among patients with recovery PVCs than among those without such PVCs (10.4% vs 4.6%; P < .001).
Echo abnormalities were significantly more prevalent in patients with recovery PVCs than without such PVCs (57.6% vs 42.9%), and the age- and sex-adjusted odds ratio (OR) was 1.4 (95% CI, 1.2 – 1.6; P < .001).
Cardiovascular mortality was elevated in patients with recovery PVCs, compared with those without recovery PVCs or echo abnormalities, and showed echo abnormalities (adjusted hazard ratio [HR], 3.3; 95% CI, 1.9 – 5.5; P < .001), but not for patients who experienced PVCs without such echo findings (HR, 1.5; 95% CI, 0.8 – 2.8; P = .22).
Although there was a negligible difference in mean left ventricular ejection fraction (LVEF) in patients with PVCs, compared with patients without PVCs, significantly more patients with PVCs did have reduced LVEF (14.4% vs 9.2%; P < .001).
Among patients with recovery PVCs, cardiovascular mortality was associated with increased left ventricular mass and dilatation and increased E/e′ ratio.
Recovery PVCs among patients without acute coronary syndrome (ACS) at baseline were associated with incident ACS follow-up, whether or not there were also echo abnormalities: HR of 1.7 (95% CI, 1.1 – 2.6) without and HR of 2.9 (95% CI, 2.0 – 4.2) with echo abnormalities.

Limitations

The analysis was limited to patients who underwent an exercise stress test and then echocardiography within 90 days. However, results were similar in a sensitivity analysis that included patients with echocardiography more than 90 days after a stress test.
No information on coronary anatomy, any subsequent evaluations for coronary artery disease, or causes of death were available.
Patients defined as not having PVCs could have experienced them below the defined threshold, that is up to three PVCs during the first 4 minutes of recovery.
Patient classification was limited to the presence or absence of PVC as defined without consideration of ventricular arrhythmia complexity.

Disclosures

The study was supported by the Swedish Heart-Lung Foundation, Swedish Cardiac Society, Royal Swedish Academy of Sciences, Women and Health Foundation, Region Kronoberg, Swedish Heart and Lung Association, Swedish Association of Clinical Physiology, Scandinavian Society of Clinical Physiology & Nuclear Medicine, Swedish Research Council, county council of Östergötland, Heart Research Australia, and University of Sydney.
The authors declared no conflicts of interest.

This is a summary of a preprint research study, Prognostic Implications of Structural Heart Disease and Premature Ventricular Contractions in Recovery of Exercise, written by Thomas Lindow, MD, PhD, from the Kolling Institute, Royal North Shore Hospital, University of Sydney, Australia, and colleagues on MedRxiv.org provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on MedRxiv.org.

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