Document Detail

Ventricular arrhythmias during clinical treadmill testing and prognosis.
MedLine Citation:
PMID:  18227372     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Although exercise-associated ventricular arrhythmias are frequently observed during exercise testing, their prognostic significance remains uncertain. Therefore, we aimed to evaluate the clinical correlates and prognostic significance of exercise-associated premature ventricular complexes (PVCs) during and after exercise testing. METHODS: We studied 1847 heart failure-free patients who underwent clinical treadmill testing between March 13, 1997, and January 15, 2004, in the Veterans Affairs Palo Alto Health Care System. Logistic regression was used to evaluate the clinical and exercise test associations of exercise and recovery PVCs. Propensity score-adjusted Cox survival analyses were used to evaluate the prognostic significance of exercise-associated PVCs. RESULTS: Of the 1847 subjects, 850 (46.0%) developed exercise PVCs (median rate, 0.43 per minute) and 620 (33.6%) had recovery PVCs (median rate, 0.60 per minute). Resting PVCs, age, and systolic blood pressure were key predictors of both exercise and recovery PVCs. Whereas exercise PVCs were related to the heart rate increase with exercise, recovery PVCs were related to coronary disease (previous myocardial infarction, coronary revascularization procedure, or pathological Q waves on resting electrocardiogram) and ST-segment depression. During a 5.4-year mean follow-up, 161 subjects (8.7%) died, and 53 of these deaths (32.9%) were due to cardiovascular causes. Recovery PVCs, but not exercise PVCs, were associated with 71% to 96% greater propensity-adjusted mortality rates (hazard ratio, 1.96 [95% confidence interval, 1.31-2.91] for infrequent PVCs; hazard ratio, 1.71 [95% confidence interval, 1.07-2.73] for frequent PVCs compared with subjects without PVCs), and occurrence of recovery PVCs reclassified 33.2% of subjects with intermediate-risk Duke Treadmill Scores into higher-risk subgroups. CONCLUSION: In our heart failure-free population, recovery PVCs were associated with increased mortality and augmented established risk markers.
Frederick E Dewey; John R Kapoor; Ryan S Williams; Michael J Lipinski; Euan A Ashley; David Hadley; Jonathan Myers; Victor F Froelicher
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of internal medicine     Volume:  168     ISSN:  0003-9926     ISO Abbreviation:  Arch. Intern. Med.     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-01-29     Completed Date:  2008-02-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372440     Medline TA:  Arch Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  225-34     Citation Subset:  AIM; IM    
Stanford University Medical School, Palo Alto, California, USA.
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MeSH Terms
Age Factors
Blood Pressure
Exercise Test / adverse effects*
Follow-Up Studies
Heart Rate
Middle Aged
Risk Factors
Ventricular Premature Complexes / diagnosis*,  etiology,  mortality*,  physiopathology

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