Clinical correlates and prognostic significance of exercise-induced ventricular premature beats in the community - The Framingham Heart Study
Clinical correlates and prognostic significance of exercise-induced ventricular premature beats in the community - The Framingham Heart Study
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DOI：
10.1161/01.cir.0000129762.41889.41
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发表时间：
2004-05-25
期刊：
影响因子：
37.8
通讯作者：
Vasan, RS
中科院分区：
文献类型：
--
作者：
Morshedi-Meibodi, A;Evans, JC;Vasan, RS
背景-最近的研究表明，在无症状个体中，运动时室性早搏（EVPBs）与心血管死亡率增加有关，但这种关联的机制尚不清楚。方法和结果：我们评估了2885名Framingham后代研究参与者（1397名男性，平均年龄43岁），他们没有心血管疾病，并进行了常规运动压力测试；792名参与者（27%）发生EVPBs（中位数，0.22/min）。采用Logistic回归评价EVPBs的预测因素。采用Cox模型对血管危险因素和运动变量进行校正，检验EVPBs不频繁（小于或等于中位数）、频繁（大于中位数）与无EVPBs与硬冠状动脉疾病（冠心病）事件（公认的心肌梗死、冠状动脉功能不全或冠心病死亡）发生率和全因死亡率的关系。年龄和男性是EVPBs的关键相关因素。在随访期间（平均15年），142人（113名男性）首次发生硬性冠心病事件，171人（109名男性）死亡。EVPBs与硬冠心病事件无关，但与全因死亡率增加相关（多变量调整后的危险比，1.86,95% CI，不频繁的为1.24 - 2.79，频繁的为1.71,95% CI, 1.18 - 2.49）。EVPBs与死亡风险的关系不受VPB等级、恢复性VPB的存在、左心室功能障碍或缺血性st段反应的影响。结论：在我们以社区为基础的大量无症状个体样本中，EVPBs与死亡风险增加相关的阈值远低于之前报道的阈值。需要进一步的研究来证实这些发现并阐明潜在的机制。
Background - Recent investigations suggest that ventricular premature beats during exercise (EVPBs) are associated with increased cardiovascular mortality in asymptomatic individuals, but mechanisms underlying the association are unclear.Method and Results - We evaluated 2885 Framingham Offspring Study participants ( 1397 men; mean age, 43 years) who were free of cardiovascular disease and who underwent a routine exercise stress test; 792 participants (27%) had development of EVPBs ( median, 0.22/min of exercise). Logistic regression was used to evaluate predictors of EVPBs. Cox models were used to examine the relations of infrequent ( less than or equal to median) and frequent ( greater than median) versus no EVPBs to incidence of hard coronary heart disease (CHD) event ( recognized myocardial infarction, coronary insufficiency, or CHD death) and all-cause mortality, adjusting for vascular risk factors and exercise variables. Age and male sex were key correlates of EVPBs. During follow-up ( mean, 15 years), 142 ( 113 men) had a first hard CHD event and 171 participants ( 109 men) died. EVPBs were not associated with hard CHD events but were associated with increased all-cause mortality rates (multivariable-adjusted hazards ratio, 1.86, 95% CI, 1.24 to 2.79 for infrequent, and 1.71, 95% CI, 1.18 to 2.49 for frequent EVPBs versus none). The relations of EVPBs to mortality risk were not influenced by VPB grade, presence of recovery VPBs, left ventricular dysfunction, or an ischemic ST-segment response.Conclusions - In our large, community-based sample of asymptomatic individuals, EVPBs were associated with increased risk of death at a much lower threshold than previously reported. Additional studies are needed to confirm these findings and to clarify the underlying mechanisms.