Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2021 Dec 7;78(23):2267-2277.
doi: 10.1016/j.jacc.2021.09.1366.

Exercise-Induced Ventricular Ectopy and Cardiovascular Mortality in Asymptomatic Individuals

Marwan M Refaat  1 , Charbel Gharios  2 , M Vinayaga Moorthy  3 , Farah Abdulhai  4 , Roger S Blumenthal  5 , Miran A Jaffa  6 , Samia Mora  7
Affiliations
Multicenter Study

Exercise-Induced Ventricular Ectopy and Cardiovascular Mortality in Asymptomatic Individuals

Marwan M Refaat et al. J Am Coll Cardiol. .

Abstract

Background: The prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear.

Objectives: This study sought to investigate whether high-grade PVCs during stress testing predict mortality in asymptomatic individuals.

Methods: A cohort of 5,486 asymptomatic individuals who took part in the Lipid Research Clinics prospective cohort had baseline interview, physical examination, blood tests, and underwent Bruce protocol treadmill testing. Adjusted Cox survival models evaluated the association of exercise-induced high-grade PVCs (defined as either frequent (>10 per minute), multifocal, R-on-T type, or ≥2 PVCs in a row) with all-cause and cardiovascular mortality.

Results: Mean baseline age was 45.4 ± 10.8 years; 42% were women. During a mean follow-up of 20.2 ± 3.9 years, 840 deaths occurred, including 311 cardiovascular deaths. High-grade PVCs occurred during exercise in 1.8% of individuals, during recovery in 2.4%, and during both in 0.8%. After adjusting for age, sex, diabetes, hypertension, lipids, smoking, body mass index, and family history of premature coronary disease, high-grade PVCs during recovery were associated with cardiovascular mortality (hazard ratio [HR]: 1.82; 95% CI: 1.19-2.79; P = 0.006), which remained significant after further adjusting for exercise duration, heart rate recovery, achieving target heart rate, and ST-segment depression (HR: 1.68; 95% CI: 1.09-2.60; P = 0.020). Results were similar by clinical subgroups. High-grade PVCs occurring during the exercise phase were not associated with increased risk. Recovery PVCs did not improve 20-year cardiovascular mortality risk discrimination beyond clinical variables.

Conclusions: High-grade PVCs occurring during recovery were associated with long-term risk of cardiovascular mortality in asymptomatic individuals, whereas PVCs occurring only during exercise were not associated with increased risk.

Keywords: cardiac arrhythmia; cardiovascular disease; heart disease; premature ventricular contraction; stress test; ventricular ectopy.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures Dr Gharios was supported by the Fogarty International Center and Office of Dietary Supplements of the National Institutes of Health under Award Number D43 TW009118 via the Scholars in HeAlth Research Program (SHARP) at the American University of Beirut. Dr Mora was supported by NHLBI K24HL 136852. The funders had no role in the design or conduct of the study; in the collection, analysis, and interpretation of the data; and in the preparation, review, or approval of the manuscript. Dr Mora has served as a consultant to Pfizer and Quest Diagnostics for work unrelated to the current study. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1.
Figure 1.. Cumulative probability curves of cardiovascular and all-cause mortality.
The shown curves are age- and sex-adjusted. Exercise-induced PVCs seem to confer a long-term (as opposed to short-term) mortality risk as shown by more pronounced red and blue curves separations as follow-up time increases. The curves seem to diverge somewhat more for high-grade PVCs during recovery rather than those during exercise, and more so for cardiovascular mortality rather than all-cause mortality. PVC: Premature ventricular contraction
Figure 2.
Figure 2.. Adjusted HRs of cardiovascular mortality for recovery high-grade PVCs.
Results are shown by clinical subgroups (sex, hypertension, diabetes, LDL category). HRs were adjusted for both clinical (age, sex, diabetes, hypertension, smoking, LDL- and HDL-cholesterol, triglycerides, body mass index, family history of premature coronary artery disease) and exercise test variables (exercise duration (in minutes), heart rate recovery (in beats per minute), achieving target heart rate, ST depression ≥ 1mm). As shown by p-interactions > 0.05, there were no significant differences between subgroups. HRs: Hazard Ratios PVCs: Premature ventricular contractions Note: p-interaction with high-grade PVCs during recovery was p=0.261 for sex, p=0.220 for diabetic status, p=0.147 for hypertensive status, p=0.801 for LDL category.
Central Illustration.
Central Illustration.. Prognostic value of exercise-induced PVCs in asymptomatic individuals.
This figure summarizes how high-grade PVCs were defined in this study. It shows that in asymptomatic individuals, only high-grade PVCs during recovery and not the exercise phase independently associate with cardiovascular mortality. The arrows indicate the prognostic role of PVCs timing (during exercise versus recovery). PVCs: Premature ventricular contractions
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bruce RA, DeRouen TA, Hossack KF. Value of maximal exercise tests in risk assessment of primary coronary heart disease events in healthy men. Five years’ experience of the Seattle heart watch study. Am J Cardiol 1980;46:371–8. - PubMed
    1. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med 1999;341:1351–7. - PubMed
    1. Gordon DJ, Ekelund LG, Karon JM et al. Predictive value of the exercise tolerance test for mortality in North American men: the Lipid Research Clinics Mortality Follow-up Study. Circulation 1986;74:252–61. - PubMed
    1. Rywik TM, Zink RC, Gittings NS et al. Independent prognostic significance of ischemic ST-segment response limited to recovery from treadmill exercise in asymptomatic subjects. Circulation 1998;97:2117–22. - PubMed
    1. Jouven X, Zureik M, Desnos M, Courbon D, Ducimetière P. Long-term outcome in asymptomatic men with exercise-induced premature ventricular depolarizations. N Engl J Med 2000;343:826–33. - PubMed

Publication types