Abstract 14222: Ventricular Ectopy is a Risk Factor for Incident Heart Failure and Mortality in the Setting of Normal Cardiac Function in the Cardiovascular Health Study
Introduction: Successful ablation of premature ventricular contractions (PVC) in heart failure patients has been shown to improve left ventricular function, but the association of PVCs with the development of left ventricular dysfunction in patients with normal baseline cardiac function is unknown.
Hypothesis: A higher PVC burden is associated with decreased systolic function and increased incident congestive heart failure (CHF) and mortality.
Methods: The Cardiovascular Health Study (CHS) enrolled 5,888 individuals 65 years or older between 1989 and 1990 from a random sample of Medicare beneficiaries at four academic centers. We included all CHS participants who at baseline had 24 hour Holter monitoring, normal left ventricular ejection fraction (LVEF), and the absence of clinical CHF. PVC/hour (in quartiles and continuously after log transformation) was assessed as a predictor of the log transformed outcome of change in left ventricular end-diastolic diameter (LVEDD) and the dichotomized outcome of reduction in LVEF between the baseline and year 5 echocardiograms using linear and logistic regression, respectively. Associations with incident CHF and all-cause mortality were assessed using Cox proportional hazards models.
Results: The 1,231 participants were followed for a median 13.2 years (interquartile rage [IQR] 7.7 - 18.2), with 352 incident CHF events recorded. The median number of PVC/hour was 1 (IQR 0 - 6). No meaningful relationship between PVC/hour and the percent change in LVEDD was observed (Table). However, in adjusted and unadjusted analyses, both the upper quartile of the PVC/hour and continuous PVC/hour were associated with a statistically greater odds of a reduction in LVEF and a significantly greater risk of incident CHF and mortality (Table).
Conclusion: In the setting of normal baseline cardiac function, higher PVC burden is associated with a decrease in LVEF over 5 years and a higher risk of incident CHF and death.
- © 2013 by American Heart Association, Inc.