Prognostic significance of PVCs and resting heart rate

Abstract

Background: We sought to evaluate the prognostic significance of premature ventricular contractions (PVCs) on a routine electrocardiogram (ECG) and to evaluate the relationship between heart rate and PVCs.

Methods: Computerized 12-lead ECGs of 45,402 veterans were analyzed. Vital status was available through the California Health Department Service.

Results: There were 1731 patients with PVCs (3.8%). Compared to patients without PVCs, those with PVCs had significantly higher all-cause (39% vs 22%, P < 0.001) and cardiovascular mortality (20% vs 8%, P < 0.001). PVCs remain a significant predictor even after adjustment for age and other ECG abnormalities. The presence of multiple PVCs or complex morphologies did not add significant additional prognostic information. Those patients with PVCs had a significantly higher heart rate than those without PVCs (mean +/- SD: 78.6 +/- 15 vs 73.5 +/- 16 bpm, P < 0.001). When patients were divided into groups by heart rate (<60, 60-79, 80-99 and >100 bpm) and by the presence or absence of PVCs, mortality increased progressively with heart rate and doubled with the presence of PVCs. Using regression analysis, heart rate was demonstrated to be an independent and significant predictor of PVCs.

Conclusions: PVCs on a resting ECG are a significant and independent predictor of all-cause and cardiovascular mortality. Increased heart rate predicts mortality in patients with and without PVCs and the combination dramatically increases mortality. These findings together with the demonstrated independent association of heart rate with PVCs suggest that a hyperadrenergic state is present in patients with PVCs and that it likely contributes to their adverse prognosis.

Figure 1

Differences in cardiovascular mortality between patients without PVCs (black) and those with PVCs (gray) are shown. Within each heart rate group, there is a significant increase in mortality when PVCs are present (P < 0.001). Mortality also increases as heart rate increases in both patients with and without PVCs (P < 0.001). PVC = premature ventricular contraction.

Figure 2

Kaplan–Meier cumulative survival curves demonstrate decreasing survival with increasing heart rate among patients without PVCs and more significant declines in survival in those with PVCs. The curves followed a consistent order with increasing mortality with increasing rate and with the matching color coded line with PVCs exhibiting an increased mortality. PVC = premature ventricular contraction.