TY - JOUR T1 - Ventricular Ectopy as a Predictor of Heart Failure and Death. JF - J Am Coll Cardiol Y1 - 2015 A1 - Dukes, Jonathan W A1 - Dewland, Thomas A A1 - Vittinghoff, Eric A1 - Mandyam, Mala C A1 - Heckbert, Susan R A1 - Siscovick, David S A1 - Stein, Phyllis K A1 - Psaty, Bruce M A1 - Sotoodehnia, Nona A1 - Gottdiener, John S A1 - Marcus, Gregory M KW - Aged KW - Catheter Ablation KW - Echocardiography KW - Electrocardiography, Ambulatory KW - Female KW - Forecasting KW - Heart Failure KW - Humans KW - Male KW - Risk Factors KW - Stroke Volume KW - Ventricular Premature Complexes AB -

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.

OBJECTIVES: 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.

VL - 66 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26160626?dopt=Abstract ER -