Summary of all studies with asymptomatic patients without clinical heart disease included in the meta-analysis
| Patients without clinical evidence of cardiac disease | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Authors; absence or presence of clinical heart disease | Subjects; study type | Exclusion criteria; reasons for exercise test | Total no. of patients with EI-PVC | Exercise protocol | Mean age; % male | Patient characteristics; mean EF/LV function assessment | Confounder adjustment; statistics method | % with ischaemia on exercise test | EI-PVC definition; EI-PVC specification | End points | Follow-up (years); lost to F/U | RR of endpoints in patients with EI-PVCs compared to control Assessment of bias
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| Busby et al,16 No clinical evidence of heart disease | Asymptomatic. Absence of cardiac disease by history and ECG Prospective cohort | Clinical heart disease. On cardiac meds, abnormal ECG | 80 | Modified Balke | 64 73% | 25% HTN, 22% Sm 5% DM, 15% lipid 0% MI Not available | Ischaemic ET, thallium perfusion defect; HTN, smoking, DM, cholesterol, age, gender Age and gender matched control | 16% | Frequent PVCs defined as 10% of all QRS complexes in 1 min or VT during and post-exercise 9% had rest PVCs. All had EI-PVCs >10% of QRS; no info on proportion of recovery EI-PVCs. 45% had complex EI-PVCs | CV events—angina non-fatal MI, syncope | 5.6 2% lost to FU | 0.78 (0.29 to 2.09) Adjusted SB—No CB—LV dysfunction confounder DB—CC AB—CC |
| Jouven et al4 No clinical evidence of heart disease | Asymptomatic patients free from CAD Prospective cohort | Known or suspected CVD, BP >180, abnormal ECG | 138 Hx free of angina and MI, ECG | Bike protocol | 47 100% | 1.4% DM 0% MI Not available | Age, blood pressure, diabetes, smoking Cox regression | 6% | Frequent EI-PVCs defined as Run of 2 or more or 10% of all QRSs During and post-exercise 2.2% had rest PVCs, 15% continued to have PVCs during recovery. No info on PVC morphology | CV mortality | 23 5.5% lost to FU | 2.53 (1.65 to 3.88) Adjusted SB—No CB—LV dysfunction as possible confounder DB—FU data reviewed by independent committee AB—CC |
| Mora et al,5 No clinical evidence of heart disease | Asymptomatic patients free from CAD Prospective cohort | Pregnant >30 years, >80 years, angina, mi, claudication, stroke, LVH | 229 Hx free of angina and MI | Bruce | 52 0% | 3% DM, 34% Sm Not available | Age, HTN, DM, smoking, ischaemic ET Cox regression | N/A | EI-PVCs defined as multifocal or at least 10% PVC in last stage of exercise or recovery No info on rest PVCs, recovery PVCs, PVC frequency or morphology | CV mortality | 20.3 No info | 1.69 (1.11 to2.58) Adjusted SB—No CB—LV dysfunction, as possible confounder DB—2 readers AB—CC |
| Morshedi-Meibodi et al,6 (Infrequent EI-PVC) No clinical evidence of heart disease | Asymptomatic patients free from overt CAD Prospective cohort | CVD, valvular heart disease, COPD | 399 Hx free of angina and MI, physical exam, ECG, M-mode echo | Bruce | 44 54% | 17% HTN, 3% DM, normal FS 99.5%, 0% MI 99.5% have normal fractional shortening | Age, HTN, smoking, DM, ischaemic ET, complexity of EI-PVCs, LV function Cox regression | 8% | Infrequent EI-PVCs defined as <0.22 EI-PVC/min During and post-exercise 0% had rest PVC, 22% had PVC during recovery, multifocal, 3% couplets; 4%, 0% VT | All cause mortality | 15 2 were lost to FU | 1.86 (1.24 to 2.79) Adjusted SB—No CB—Possible undetected silent coronary disease, channelopathy, hypertensive heart DB—3 readers AB—CC |
| Morshedi-Meibodi et al6 (frequent EI-PVC) No clinical evidence of heart disease | asymptomatic patients free from overt CAD Prospective cohort | CVD, valvular heart disease, COPD | 393 Hx free of angina and MI, physical exam, ECG, M-mode echo | Bruce | 47 56% | 28% HTN, 3% DM, normal FS 99.2%, 0% MI, 99.8% have normal fractional shortening | Age, HTN, smoking, DM, ischaemic ET, complexity of EI-PVCs, LV function Cox regression | 9% | Frequent EI-PVCs defined as >0.22 EI-PVC/min During and post-exercise 0% had rest PVC, 44% had PVC during recovery; 22% multifocal, 17% couplets, 3% VT | All cause mortality | 15 2 were lost to FU | 1.71 (1.18–2.49) Adjusted SB—No CB—Possible undetected silent coronary disease, channelopathy, hypertensive heart DB—3 readers AB—CC |
AB, attrition bias; AF, atrial fibrillation; Angio, angiogram; CABG, coronary artery bypass graft operation; CAD, coronary artery disease; CCF, congestive cardiac failure; CV, cardiovascular; CB, confounder bias; CVD, cardiovascular disease; CVRF, cardiovascular risk factors; COPD, chronic obstructive pulmonary disease; CXR, chest X-ray; DB, detection bias; DM, diabetes mellitus; Def, definition; Echo, echocardiogram; EF, ejection fraction; ET, exercise test; ESRF, end stage renal failure; Freq, frequency; HTN, hypertension; Info, information; Hx, history; Info, information; LVH, left ventricular hypertrophy; Meds, medications; MI, myocardial infarction; MPS, myocardial perfusion SPECT; PVC, premature ventricular complex; N, number; NS, not specified; PCI, percutaneous coronary intervention; Sm, smoker; SB, selection bias; TVD, triple vessel disease; VHD, valvular heart disease; VT, ventricular tachycardia.