Refaat MM etc. J Am Coll Cardiol. 2021;doi:10.1016/j.jacc.2021.09.1366.
Refaat MM etc. J Am Coll Cardiol. 2021;doi:10.1016/j.jacc.2021.09.1366.
Researchers report that in asymptomatic patients without a history of CVD, high premature ventricular contractions during recovery after exercise stress testing can predict long-term CV mortality.
However, according to data published in the Journal of the American College of Cardiology, high-grade premature ventricular beats (PVC) observed during exercise are not associated with all-cause mortality and cardiovascular mortality.
"Currently, most clinicians tend to ignore PVCs that occur during stress testing, but here we show that PVCs that occur during recovery—especially if they appear two or more consecutively, frequently, multifocal, or R-on-T-high-risk asymptomatic individuals who may benefit from further strengthening prevention efforts," Associate Professor of Harvard Medical School, Director of Lipid Metabolomics Center at Brigham and Women's Hospital, MD, MHS Samia· Samia Mora told Healio. "Importantly, the risks posed by these advanced PVCs—the risk of cardiovascular death is approximately 80% higher—has nothing to do with standard risk factors or even other exercise test variables, and they mainly determine that they are more likely to die after 10 years. Individuals with cardiovascular disease. Follow up. This is in contrast to PVCs that only occur during exercise. After considering other CV or exercise test variables, PVC is not associated with increased risk."
The researchers evaluated 5,486 asymptomatic participants in a prospective cohort of the Lipid Research Clinic. The average age was 45 years, 42% were women, and the average follow-up time was 20 years.
Researchers found high-level PVC during exercise in 1.8% of participants and 2.4% of participants during exercise recovery-defined as frequent (>10 times per minute), multifocal, R-on-T or continuous 2 More than one PVC. Exercise, and according to the results, 0.8% of the participants during exercise and recovery.
Refaat and colleagues wrote that in the presence of high-grade PVC during exercise recovery, there is a difference in the probability of all-cause mortality and cardiovascular mortality.
Researchers report that the high-grade PVC observed during recovery is associated with cardiovascular mortality (adjusted HR = 1.59; 95% CI, 1.09-2.3; P = .015), but no high-grade observed during exercise The same association for PVC (aHR = 1.16; 95% CI, 0.73-1.85; P = .527).
After adjusting for age, gender, and traditional risk factors (aHR = 1.82; 95% CI, 1.19-2.79; P = .006) and the duration of exercise, the relationship between high-grade PVC during recovery and cardiovascular mortality The correlation is still significant, the heart rate is restored, the target heart rate is reached, and the ST segment depression is achieved (aHR = 1.68; 95% CI, 1.09-2.6; P = .02).
In the subgroup analysis, there was no significant difference in the association between high-grade PVC recovery and cardiovascular mortality in men or women and patients with or without diabetes, hyperlipidemia, or hypertension (interaction P> 0.05).
"These results support the conclusions of earlier studies of high-risk groups, because previous studies of symptomatic people and studies of asymptomatic French police have also found that high-grade restorative PVC poses an increased risk," Mora told Healio . "We think these PVCs may indicate insufficient reactivation of the vagus nerve after exercise, because it is known that the parasympathetic nervous system is activated immediately after stopping exercise to counteract the sympathetic nervous system of the autonomic nervous system.
"From a practical point of view, in addition to reporting MET, exercise blood pressure, and post-exercise heart rate recovery, exercise test reports must also include comments on high-level recovery of PVC in their summary statements. This is true for busy clinicians The most helpful thing is that they usually only have time to read the summary statement of the stress test, because these stress test measures have been shown to carry independent prognostic information," Mora told Healio.
"The current study shows for the first time that, even after adjusting for demographic and clinical variables, high-intensity exercise-induced PVC during recovery (but not during exercise) and CV death in asymptomatic adults without previous CV disease Higher risks are related to non-ischemic exercise performance parameters," Sandeep A. Saha, MD, MS, a cardiologist at the Oregon Heart Center, wrote in a related editorial.
"The current study does not show any prognostic value of exercise-induced PVC for all-cause mortality, and cannot prove the utility of exercise-induced PVC during the recovery period in reclassifying the long-term CV death risk of this population," Saha wrote . "Therefore, these findings support current guidelines, which do not recommend exercise stress testing as a screening test for low-risk CAD patients."
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