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(Circulation. 2004;109:2417-2422.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

Clinical Correlates and Prognostic Significance of Exercise-Induced Ventricular Premature Beats in the Community

The Framingham Heart Study

Ali Morshedi-Meibodi, MD; Jane C. Evans, DSc; Daniel Levy, MD; Martin G. Larson, ScD; Ramachandran S. Vasan, MD

From the National Heart, Lung, and Blood Institute’s Framingham Heart Study (A.M.M., M.G.L., D.L., R.S.V.), Framingham, Mass; the Divisions of Cardiology and Clinical Epidemiology, Beth Israel Hospital (D.L.), Harvard Medical School, Boston, Mass; the National Heart, Lung, and Blood Institute, Bethesda, Md (D.L.); and the Cardiology Section (R.S.V.) and Department of Preventive Medicine and Epidemiology (R.S.V., M.G.L., D.L.), Boston University School of Medicine, Boston, Mass.

Correspondence to Ramachandran S. Vasan, MD, Framingham Heart Study, 73, Mt Wayte Avenue, Suite 2, Framingham, MA 01702–5827. E-mail vasan{at}bu.edu

Received November 26, 2003; revision received February 25, 2004; accepted February 25, 2004.

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.

Key Words: exercise • mortality • ventricles • cardiovascular diseases • arrhythmia

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