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Meta-Analysis
. 2023 Aug;66(5):1145-1163.
doi: 10.1007/s10840-022-01421-8. Epub 2022 Nov 21.

Risk factors for the development of premature ventricular complex-induced cardiomyopathy: a systematic review and meta-analysis

Jeanne du Fay de Lavallaz  1 , Julien Mézier  1 , Lara Mertz  1 , Diego Mannhart  1 , Teodor Serban  1 , Sven Knecht  1 , Qurrat-Ul-Ain Abid  2 , Tai Tri Nguyen  2 , Michael Kühne  1 , Christian Sticherling  1 , Henry Huang  2 , Michael R Gold  3 , Patrick Badertscher  4
Affiliations
Meta-Analysis

Risk factors for the development of premature ventricular complex-induced cardiomyopathy: a systematic review and meta-analysis

Jeanne du Fay de Lavallaz et al. J Interv Card Electrophysiol. 2023 Aug.

Abstract

Background: Premature ventricular complexes (PVCs) are a potentially reversible cause of heart failure. However, the characteristics of patients most likely to develop impaired left ventricular function are unclear. Hence, the objective of this study is to systematically assess risk factors for the development of PVC-induced cardiomyopathy.

Methods: We performed a structured database search of the scientific literature for studies investigating risk factors for the development of PVC-induced cardiomyopathy (PVC-CM). We investigated the reporting of PVC-CM risk factors (RF) and assessed the comparative association of the different RF using random-effect meta-analysis.

Results: A total of 26 studies (9 prospective and 17 retrospective studies) involving 16,764,641 patients were analyzed (mean age 55 years, 58% women, mean PVC burden 17%). Eleven RF were suitable for quantitative analysis (≥ 3 occurrences in multivariable model assessing a binary change in left ventricular (LV) function). Among these, age (OR 1.02 per increase in the year of age, 95% CI [1.01, 1.02]), the presence of symptoms (OR 0.18, 95% CI [0.05, 0.64]), non-sustained ventricular tachycardias (VT) (OR 3.01, 95% CI [1.39, 6.50]), LV origin (OR 2.20, 95% CI [1.14, 4.23]), epicardial origin (OR 4.72, 95% CI [1.81, 12.34]), the presence of interpolation (OR 4.93, 95% CI [1.66, 14.69]), PVC duration (OR 1.05 per ms increase in QRS-PVC duration [1.004; 1.096]), and PVC burden (OR 1.06, 95% CI [1.04, 1.08]) were all significantly associated with PVC-CM.

Conclusions: In this meta-analysis, the most consistent risk factors for PVC-CM were age, non-sustained VT, LV, epicardial origin, interpolation, and PVC burden, whereas the presence of symptoms significantly reduced the risk. These findings help tailor stringent follow-up of patients presenting with frequent PVCs and normal LV function.

Keywords: Hear failure; PVC-induced cardiomyopathy; Premature ventricular contractions; Ventricular arrhythmias.

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Conflict of interest statement

Sven Knecht has received funding of the “Stiftung für Herzschrittmacher und Elektrophysiologie.”

Michael Kühne reports personal fees from Bayer, personal fees from Böhringer Ingelheim, personal fees from Pfizer BMS, personal fees from Daiichi Sankyo, personal fees from Medtronic, personal fees from Biotronik, personal fees from Boston Scientific, personal fees from Johnson & Johnson, personal fees from Roche, grants from Bayer, grants from Pfizer, grants from Boston Scientific, grants from BMS, grants from Biotronik, and grants from Daiichi Sankyo, all outside the submitted work.

Christian Sticherling is a Member of Medtronic Advisory Board Europe and Boston Scientific Advisory Board Europe, received educational grants from Biosense Webster and Biotronik and a research grant from the European Union’s FP7 program and Biosense Webster, and lecture and consulting fees from Abbott, Medtronic, Biosense-Webster, Boston Scientific, Microport, and Biotronik, all outside the submitted work.

Patrick Badertscher has received research funding from the “University of Basel,” the “Stiftung für Herzschrittmacher und Elektrophysiologie,” the “Freiwillige Akademische Gesellschaft Basel,” and Johnson & Johnson, all outside the submitted work and reports personal fees from Abbott.

Jeanne du Fay de Lavallaz has received research funding from the “University of Basel” and from the “Swiss Heart Foundation.”

Henry Huang has received research funding from Medtronic, educational grants from Medtronic, Biotronik, Abbott, and Boston Scientific, and consulting fees from Biosense-Webster and Cardiofocus.

Michael Gold is a consultant to Boston Scientific and Medtronic, as well as on steering committees with Boston Scientific, Abbott, and Medtronic.

Others have nothing to declare.

Figures

Fig. 1
Fig. 1
Study selection chart flow
Fig. 2
Fig. 2
Random effects model showing the overall effect of age on the risk of developing PVC-CM. TE, estimate of treatment effect; seTE, standard error of treatment estimate; OR, odds ratio; CI, confidence interval
Fig. 3
Fig. 3
Random effects model showing the overall effect of overall PVC burden on the risk of developing PVC-CM. TE, estimate of treatment effect; seTE, standard error of treatment estimate; OR, odds ratio; CI, confidence interval
Fig. 4
Fig. 4
Random effects model showing the overall effect of epicardial origin of the PVC on the risk of the developing PVC-CM. TE, estimate of treatment effect; seTE, standard error of treatment estimate; OR, odds ratio; CI, confidence interval
Fig. 5
Fig. 5
Random effects model showing the overall effect of interpolated PVCs on the risk for PVC-CM. TE, estimate of treatment effect; seTE, standard error of treatment estimate; OR, odds ratio; CI, confidence interval
Fig. 6
Fig. 6
Random effects model showing the overall effect of left ventricular origin of the PVC on the risk of the developing PVC-CM. TE, estimate of treatment effect; seTE, standard error of treatment estimate; OR, odds ratio; CI, confidence interval
Fig. 7
Fig. 7
Random effects model showing the overall effect of non-sustained ventricular tachycardia on the risk for PVC-CM. TE, estimate of treatment effect; seTE, standard error of treatment estimate; OR, odds ratio; CI, confidence interval
Fig. 8
Fig. 8
Random effects model showing the overall effect of symptoms on the risk for PVC-CM. TE, estimate of treatment effect; seTE, standard error of treatment estimate; OR, odds ratio; CI, confidence interval
Fig. 9
Fig. 9
Random effects model showing the effect of PVC duration (per ms increase in QRS PVC duration) on the risk for PVC-CM. TE, estimate of treatment effect; seTE, standard error of treatment estimate; OR, odds ratio; CI, confidence interval
Fig. 10
Fig. 10
Dose–response plot of PVC burden and association with PVC-CMP. Based on 7 studies reporting PVC burden with a cutoff, a dose–response analysis was conducted. The black line represents the predicted increase in PVC-CMP risk associated with an increase in PVC burden in %. The gray ribbon represents the confidence interval of the prediction
Fig. 11
Fig. 11
Assessment of publication bias using a contour-enhanced funnel plot. The contour-enhanced funnel plot represents the different studies reporting estimated for the association between PVC burden (continuous increase in %) and assess the risk for publication bias. The 7 studies reporting a cutoff of PVC burden were summarized beforehand as the “dose–response analysis.” The dotted line represents the overall estimate using all available studies and the dashed line represents a classical funnel plot with the expected distribution of the studies if no publication bias is present. The contour-enhanced funnel plot is centered at 0 (i.e., the value under the null hypothesis of no relationship) and various levels of statistical significance are indicated by the shaded region. The white region corresponds to non-significant P values. Highly significant P values appear in the light gray region
Fig. 12
Fig. 12
Assessment of study quality. Evaluation of study quality according to the QUIPS tool. Five domains of bias (participation, attrition, prognostic factor measurement, outcome measurement, confounding and statistical analysis and reporting) are represented with the associated risk of bias (high in red, moderate in yellow, and low in green). The overall column represents the mean risk of bias from the 6 domains
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