Relation of ventricular premature complexes to heart failure (from the Atherosclerosis Risk In Communities [ARIC] Study)

Abstract

Analogous to rapid ventricular pacing, frequent ventricular premature complexes (VPCs) can predispose over time to cardiomyopathy and subsequent heart failure (HF). We examined the association of frequent VPCs with HF incidence in a population-based cohort, free of HF and coronary heart disease at baseline. At study baseline (1987 to 1989), ≥1 VPC on a 2-minute rhythm electrocardiographic strip was seen in 5.5% (739 of 13,486) of the middle-age (45 to 64 years old at baseline) white and black, men and women of the Atherosclerosis Risk In Communities cohort. Incident HF was defined as the first appearance of International Classification of Diseases code 428.x in the hospital discharge record or death certificate through 2005. During an average follow-up of 15.6 years, incident HF was seen in 10% the participants (19.4% of those with VPCs vs 9.4% of those without). The age-, race-, and gender-adjusted hazard ratio of HF for VPCs was 1.89 (95% confidence interval 1.59 to 2.24). After multivariable adjustment for potential confounders, the hazard ratio of HF for those with any VPC versus no VPC was 1.63 (95% confidence interval 1.36 to 1.96). After additional adjustment for incident coronary heart disease as a time-varying covariate, the hazard ratio was 1.71 (95% confidence interval 1.42 to 2.08). Those with a greater frequency of VPCs or complex VPCs had similar rates of HF compared to those with a single VPC and all had rates greater than those with no VPC. In conclusion, in this large population-based cohort, the presence of VPCs was associated with incident HF, independent of incident coronary heart disease.

Figure 1

Multivariable adjusted cumulative heart failure events during follow up by the presence any VPCs (143 HF events among 739) vs. absence (1201 HF events among 12747) events in a 2-minute ECG strip among ARIC cohort participants free of heart failure and coronary heart disease at study baseline. (Wilcoxon test P<0.001). Model adjusted for age, gender, race, study center, education level, diabetes, systolic blood pressure, hypertension medication intake, LDL and HDL cholesterol, BMI, current smoking, former smoking, pack-years of smoking, amount of ethanol use, heart rate, serum K+, serum Mg++.

Figure 2

Hazards ratio of Heart Failure by presence of single (n=298), two-or-more (n = 358), and complex (n = 83) Ventricular premature complexes (VPCs) as compared to no (n = 12747) VPCs in a cohort of middle aged men and women free of CHD at baseline. Cox proportional hazards model adjusted for age, gender, race, study center, education level, diabetes, systolic blood pressure, hypertension medication intake, LDL and HDL cholesterol, BMI, current smoking, former smoking, pack-years of smoking, amount of ethanol use, heart rate, serum K⁺, serum Mg⁺⁺. Results from the ARIC study (1987 through 2005).