Arrhythmias and conduction disturbances
Usefulness of Ventricular Premature Complexes to Predict Coronary Heart Disease Events and Mortality (from the Atherosclerosis Risk In Communities Cohort)

https://doi.org/10.1016/j.amjcard.2006.06.061Get rights and content

The clinical relevance of ventricular premature complexes (VPCs) in apparently healthy patients is not clear and is typically not considered when evaluating risk. We conducted a prospective longitudinal study of the population-based Atherosclerosis Risk In Communities (ARIC) study of 15,070 Caucasians and African-Americans, 45 to 64 years of age, to assess the risks of coronary heart disease (CHD) events and mortality associated with VPCs among participants with and without prevalent CHD at baseline. VPCs on a single 2-minute electrocardiogram were identified in 940 participants (6.2%). After a follow-up of >10 years, 1,762 participants died, with 366 deaths related to CHD, and 1,736 had cardiac events. The percentage of participants with CHD mortality was >3 times greater for those with VPCs compared with those without VPCs. After controlling for cardiovascular risk factors and therapy with proportional hazards regression, participants with VPCs were >2 times as likely to die due to CHD than were those without VPCs. Increased risk was found for participants with and without baseline CHD. In conclusion, a clinical finding of VPCs on electrocardiography of even apparently healthy patients may warrant a heightened awareness of and attention to cardiovascular risk assessment and management.

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Methods and Results

The study population consisted of participants in the Atherosclerosis Risk In Communities (ARIC) study, a population-based prospective cohort of approximately 4,000 adults residing in each of 4 United States communities (Forsyth County, North Carolina; Jackson, Mississippi; selected suburbs of Minneapolis, Minnesota; and Washington County, Maryland). The ARIC study was designed to investigate the etiology of atherosclerosis and cardiovascular disease and their relations to race, gender, risk

Discussion

Patients with VPCs are substantially more likely to develop subsequent CHD events and mortality compared with patients without VPCs. These risks are statistically independent of CHD risk factors. VPC-associated risk is not confined to patients with established CHD, but is also found among apparently healthy patients without history or clinical manifestations of CHD.

Our finding that VPCs are associated with CHD and death illuminates a fundamental clinical concern. Randomized trials have shown

Acknowledgment

The investigators thank the staff and participants of the ARIC study for important contributions.

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    Citation Excerpt :

    A PVC beat is a pulse that appears earlier than the subsequent coming sinus pulse. PVC beats can appear in normal healthy persons, but in diseased hearts, the frequency of appearance in an ECG is increased and can be an indicator of a life threatening condition [14,15]. The main causes of PVCs and their complex samples in the heart are still poorly understood [16].

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The Atherosclerosis Risk In Communities Study is carried out as a collaborative study supported by Contracts N01-HC-55015, N01-HC-55016, N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. This research was supported by Contracts N01-HC-55018, N01-HC-55019, N01-HC-55020, N01-HC-55021, and N01-HC-55022 from the National Heart, Lung, and Blood Institute. Further support for Dr. Massing included a National Research Award Grant 5-T32-HL007055 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

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