Cardiac mortality of premature ventricular complexes in healthy people in Japan.
ABSTRACT Premature ventricular complexes (PVCs) are frequently encountered in healthy people. But the association between PVCs and cardiac events is not well established in Japan. We investigated the association of PVCs and cardiac deaths in people without cardiovascular disease in the Jichi Medical School (JMS) Cohort study.
We conducted a prospective cohort study in 12 districts in Japan as part of the JMS cohort study. Baseline data were obtained between April 1992 and July 1995. We excluded subjects who had myocardial infarction and stroke and those who had not received 12-lead electrocardiograms. Cox's proportional hazard model was used to calculate the hazard ratios (HRs) of cardiovascular mortality of subjects with PVCs, using subjects without PVCs as reference.
A total of 11,158 participants (4333 males and 6825 females) were analyzed. Participants were followed for an average of 11.9 years. PVCs were present in 1.4% of men and 1.1% of women. There were 92 cardiac deaths (47 males and 45 females) during the follow-up period. In crude cardiovascular mortality, HRs (95% confidence interval [CI]) were 5.29 (1.64-17.0) in males and 2.14 (0.29-15.5) in females. Age-adjusted HRs were 3.73 (1.16-12.0) and 0.98 (0.13-7.21), respectively. After further adjustment for body mass index, systolic blood pressure, total cholesterol level, high-density lipoprotein-cholesterol, and blood glucose, HRs were 3.98 (1.21-13.0) and 0.95 (0.13-7.11), respectively.
We conclude that PVCs are a predictive factor for cardiac death in men without structural heart disease.
- [Show abstract] [Hide abstract]
ABSTRACT: Recently, it has been reported that frequent premature ventricular contractions (PVCs) may be associated with causing heart failure in patients with left ventricular (LV) dysfunction. However, the prognostic significance of frequent PVCs in asymptomatic patients with a normal LV function is unclear. Two hundred and thirty-nine consecutive patients presenting with frequent PVCs (>1000 beats/day) originating from the right or left ventricular outflow tract without any detectable heart disease were enrolled in the study. Structural heart disease was ruled out by echocardiography and cardiac magnetic resonance imaging, and Holter-ECG monitoring was repeated two or three times to evaluate the PVC prevalence at the initial evaluation. All patients were followed up for at least 4 years, and further observation was continued if possible. During an observation period of 5.6 (1.7) years, no patients exhibited any serious cardiac events. Although there was no significant change in the mean LV ejection fraction (LVEF) and mean LV diastolic dimension (LVDd), there was a significant negative correlation between the PVC prevalence and DeltaLVEF (p<0.001) and positive correlation between the PVC prevalence and DeltaLVDd (p<0.001). When the development of LV dysfunction was defined as DeltaLVEF>-6%, 13 patients exhibited LV dysfunction. For the prediction of the development of LV dysfunction, PVC prevalence and LVEF at the initial evaluation were independent predicting factors (p<0.01). Although the prognosis in patients with frequent PVCs was considered relatively benign, attention should be paid to the progression of the LV dysfunction during a long-term observation, especially in patients with a high PVC prevalence.Heart (British Cardiac Society) 06/2009; 95(15):1230-7. · 5.01 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Left ventricular hypertrophy is a known risk factor for atrial fibrillation (AF). However, it is not well understood whether other electrocardiogram abnormalities are associated with development of AF. This was a community-based cohort study based upon a database of annual health examinations. We included 63,386 subjects aged > or = 50 years, without baseline AF (including atrial flutter), structural heart disease, or heart failure, who completed the annual examination during a 10-year follow-up period (1991-2002). The electrocardiographic risk factors for AF were studied in the subjects. Atrial fibrillation developed in 873 subjects. Age, male sex, body mass index, hypertension, systolic and diastolic blood pressure, and diabetes were significant risk factors for the development of AF. In multivariable logistic regression analysis adjusted for these risk factors, electrocardiographic left ventricular hypertrophy (odds ratio [OR], 1.43), ST-segment abnormality without left ventricular hypertrophy (OR, 1.89), and the presence of premature complexes during a 10-second recording (OR, 2.89) were significantly associated with AF, whereas either right (OR, 0.84) or left bundle branch block (OR, 0.96) was unrelated. The risk for AF increased progressively with the severity of both ST-segment change and premature complexes. ST-segment abnormality and comparably high-frequency premature complexes were each associated with increased risk for the development of AF. These electrocardiographic findings may be useful to stratify high-risk subjects for new-onset AF.American heart journal 11/2006; 152(4):731-5. · 4.65 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The association between ventricular premature complexes (VPCs) detected on a rest 2-minute lead I electrocardiographic rhythm strip and sudden cardiac death (SCD), occurring within 1 hour of onset of symptoms, was evaluated in a prospective study of 15,637 apparently healthy white men, aged 35 to 57 years, at the first screening examination (1973 to 1975) to determine eligibility for the Multiple Risk Factor Intervention Trial in Minneapolis/St. Paul, Minnesota. The prevalence of any VPC was 4.4% (681 of 15,637). Over an average follow-up period of 7.5 years, a total of 381 deaths occurred. Of these, 34% (131 of 381) were ascribed to coronary artery disease (CAD) and 31% of the CAD deaths (41 of 131) occurred suddenly. The presence of any VPC was associated with a significantly higher risk for SCD (adjusted relative risk = 3.0; p less than 0.025). On the other hand, the presence of any VPC was not associated with any significant increase in the risk of non-SCD or of total deaths from CAD (adjusted relative risk = 1.0 and 1.6, respectively). When VPC characteristics such as frequency (2 or more uniform VPCs every 2 minutes) and complexity (multiforms, pairs, runs, R-on-T) were examined, those with frequent or complex VPCs were at a significantly increased risk of SCD (adjusted relative risk = 4.2; p less than 0.005), whereas for non-SCD no significant increase in risk was found (adjusted relative risk = 1.6; p = 0.28).(ABSTRACT TRUNCATED AT 250 WORDS)The American Journal of Cardiology 12/1987; 60(13):1036-42. · 3.21 Impact Factor