The Prognostic Significance of Frequency and Morphology of Premature Ventricular Complexes during Ambulatory Holter Monitoring
The Prognostic Significance of Frequency and Morphology of Premature Ventricular Complexes during Ambulatory Holter Monitoring
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DOI：
10.1111/anec.12010
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发表时间：
2013-03-01
影响因子：
1.9
通讯作者：
Schweitzer, Paul
中科院分区：
文献类型：
--
作者：
Ephrem, Georges;Levine, Michael;Schweitzer, Paul
背景：在结构性心脏病患者中，多形态早衰心室复合体（PVCs）与不良预后相关。频繁的室性早搏与心室功能障碍有关。我们的假设是，在一般人群中，多种形式的室性早搏会导致不良预后。方法：我们对2008年7月1日至2009年12月31日在我院进行24小时动态动态监测的18岁患者进行回顾性队列研究。排除无室性早搏或更频繁异位的患者（双联体、三胞胎或非持续性室性心动过速）。从图表回顾中收集临床和不良事件（主要不良心血管事件或新发/恶化的心力衰竭）数据。数据分析的PVC频率（罕见，偶尔或频繁）和模式（均匀或多形式）。结果共纳入222例患者，其中男性43%，平均年龄55±16岁（IQR: 2.02.6），中位随访时间2.3年。中位频率为2室早/小时（IQR: 113）。多形态室性早搏占48%。多形态室性早搏患者年龄较大，且合并症发生率较高。记录了39个AE。AE患者更年轻，HTN、糖尿病、CAD、CHF和既往心肌梗死的患病率更高。与单一组（8%）相比，多形式组AE的发生率（28%）更高（P < 0.001）。增加的PVC频率与AE的高发生率相关（分别为8%、24%和35%）。在Cox回归分析中，多形式模式预测AE，而不是频率预测AE。结论：在接受动态动态心电图监测的患者中，多形态室性早搏与AE增加4倍相关。
Background Multiform premature ventricular complexes (PVCs) are associated with an adverse prognosis in patients with structural heart disease. Very frequent PVCs are associated with ventricular dysfunction. Our hypothesis is that multiform PVCs confer an adverse prognosis in the general population. Methods We performed a retrospective cohort study of patients 18 years old referred to our institution for 24-hour ambulatory Holter monitoring between July 1, 2008 and December 31, 2009. Holters without PVCs or with more frequent ectopy (couplets, triplets, or nonsustained ventricular tachycardia) were excluded. Clinical and adverse event (AE) data (major adverse cardiovascular event or new/worsening heart failure) were gathered from chart review. Data was analyzed by PVC frequency (rare, occasional, or frequent) and pattern (uniform or multiform). Results A total of 222 patients (43% male, mean age: 55 +/- 16 years) were evaluated (median follow-up 2.3 years [IQR: 2.02.6]). Median frequency was 2 PVCs per hour (IQR: 113). Multiform PVCs were noted in 48%. Patients with multiform PVCs were older, and had a higher prevalence of comorbidities. Thirty-nine AE were noted. Patients with an AE were younger, had a higher prevalence of HTN, diabetes, CAD, CHF, and previous MI. The multiform group had a higher incidence of AE (28%) compared to the uniform group (8%) (P < 0.001). Increasing PVC frequency was associated with a higher incidence of AE (8% vs 24% vs 35%, respectively). In Cox regression analyses, the multiform pattern but not frequency predicted AE. Conclusions Multiform PVCs were associated with a 4-fold increase in AE in patients referred for ambulatory Holter monitoring.