Prognostic implications of structural heart disease and premature ventricular contractions in recovery of exercise.
Prognostic implications of structural heart disease and premature ventricular contractions in recovery of exercise.
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DOI：
10.1038/s41598-022-14535-w
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发表时间：
2022-06-17
影响因子：
4.6
通讯作者：
Ugander, Martin
中科院分区：
文献类型：
--
作者：
Lindow, Thomas;Ekstrom, Magnus;Brudin, Lars;Hedman, Kristofer;Ugander, Martin
运动负荷试验恢复期间的室性早搏（PVC）与心血管死亡率增加相关，但原因尚不清楚。我们的目的是评估恢复期室性早搏与超声心动图异常的关系，以及它们的综合预后表现。在接受超声心动图和运动负荷试验的患者中，确定了恢复期超声心动图异常[左心室（LV）射血分数降低、瓣膜性心脏病、LV扩张、LV肥大或充盈压升高]和PVC。在纳入的患者中（n = 3106，年龄59 ± 16岁，55%为男性），1327例（43%）患者在恢复期发现PVC，其中超声心动图异常的患病率增加（58% vs. 43%，p < 0.001）。总体而言，恢复期PVC与心血管死亡率增加相关（219例事件，7.9 [5.4-11.1]年随访;校正风险比（HR [95%置信区间]）1.6 [1.2-2.1]，p < 0.001）。当结合超声心动图异常的存在或不存在进行分析时，恢复期PVC在存在时与风险增加相关（HR 3.3 [1.9-5.5]，p < 0.001），但在不存在时与风险增加无关（HR 1.5 [0.8-2.8]，p = 0.22），参考两者都没有的患者。我们的研究结果为PVC患者在恢复期间报告的CV风险增加提供了机制见解。
Premature ventricular contractions (PVCs) during recovery of exercise stress testing are associated with increased cardiovascular mortality, but the cause remains unknown. We aimed to evaluate the association of PVCs during recovery with echocardiographic abnormalities, and their combined prognostic performance. Echocardiographic abnormalities [reduced left ventricular (LV) ejection fraction, valvular heart disease, LV dilatation, LV hypertrophy, or increased filling pressures] and PVCs during recovery were identified among patients having undergone both echocardiography and exercise stress test. Among included patients (n = 3106, age 59 ± 16 years, 55% males), PVCs during recovery were found in 1327 (43%) patients, among which the prevalence of echocardiographic abnormalities was increased (58% vs. 43%, p < 0.001). Overall, PVCs during recovery were associated with increased cardiovascular mortality (219 total events, 7.9 [5.4–11.1] years follow-up; adjusted hazard ratio (HR [95% confidence interval]) 1.6 [1.2–2.1], p < 0.001). When analyzed in combination with either presence or absence of echocardiographic abnormalities, PVCs during recovery were associated with increased risk when such were present (HR 3.3 [1.9–5.5], p < 0.001) but not when absent (HR 1.5 [0.8–2.8], p = 0.22), in reference to those with neither. Our findings provide mechanistic insights to the increased CV risk reported in patients with PVCs during recovery.
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