PVCs and echocardiographic abnormalities during recovery associated with increased cV mortality

Exercise-induced premature ventricular contractions (PVCs) are common findings in exercise stress testing and have been described to associate with increased risk of cardiovascular (CV) mortality, especially when occurring during the recovery phase.

A recent study in MedRixv by Thomas Lindow, and team revealed that PVCs during recovery were associated with increased prevalence of echocardiographic abnormalities. Increased risk of cardiovascular mortality was observed only for subjects with PVCs if concomitant echocardiographic abnormalities were present.

The study evaluated echocardiographic abnormalities (reduced left ventricular (LV) ejection fraction, valvular heart disease, LV dilatation, LV hypertrophy, or increased filling pressures) and PVCs during recovery (≥1/min) were identified among patients having undergone echocardiography within median [interquartile range] 0 [0-2] days of an exercise stress test. The association between such changes and cardiovascular mortality was analyzed using Cox regression adjusted for age, sex, clinical and exercise variables.

The results of the study were

• Among 3,106 included patients, PVCs during recovery were found in 1,327 (43%) patients, among which the prevalence of echocardiographic abnormalities was increased (58% vs. 44%, 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 combined with 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.

Authors concluded that "PVCs during recovery were associated with increased prevalence of echocardiographic abnormalities. Increased risk of cardiovascular mortality was observed only for subjects with PVCs if concomitant echocardiographic abnormalities were present. Our findings provide mechanistic insights to the increased CV risk reported in patients with PVCs during recovery."

Reference: https://doi.org/10.1101/2021.12.22.21268216