Premature Ventricular Contractions As A Predictive Marker For Cardiac Events In Stable Heart Failure Patients

Document Type

Conference Proceeding

Publication Date

1-1-2025

Publication Title

J Card Fail

Abstract

Introduction: Even though premature ventricular contractions (PVCs) are often viewed as harmless, recent studies show that a πρεχεδινγ PVC beat might be inefficient. It suggests that even a moderate number of PVCs could reduce contractile efficiency and elevate event risk. Yet, the prevalence of moderate to high PVCs (>5%) in stable heart failure (HF) patients and the association between PVC percentage and cardiac event risk in stable HF patients are still unclear. Aim: This study aimed to quantify HF patients with >5% PVCs and to evaluate the predictive power of PVCs for cardiac events. Methods: Our study retrospectively reviewed 651 HF patients from Amsterdam UMC (AUMC) with LVEF < 40% or NTproBNP > 600 pg/ml, and 180 HF patients from Henry Ford Hospital (HFH) with LVEF < 40%. We employed a multivariable Cox regression model to evaluate predictors of cardiac events, such as all-cause mortality, VT/VF and/or ICD shocks, and cardiac arrest, selecting variables with p < 0.05 from univariable analysis. For survival models, numeric variables not fitting a normal distribution were transformed into categorical variables using ROC-derived thresholds. Results: In AUMC and HFH cohorts, the median age was 64 years, with 43.5% and 50% females, respectively. Approximately, 9-11% of patients in both cohorts had more than 5% PVCs. In AUMC cohort, individuals in the top three PVC deciles faced significantly higher event risk than lower deciles (Figure 1). Based on univariable analysis, four predictors, including PVC %, NT-proBNP, occurrences of bi/trigeminy, and NSVT were selected for inclusion in the multivariable survival model. Thresholds of 0.5% for PVCs and 6000 pg/ml for NTproBNP were used. PVCs greater than 0.5% were significantly linked to an increased risk of cardiac events, exhibiting hazard ratios (HR) greater than two across all models with significant p-values, and slightly outperforming NSVT in predictive strength. (Table 1) Conclusions: Our analysis across two independent cohorts reveals that 9-11% of stable HF patients exhibit a notable PVC burden (>5% of total beats), even with adequate treatment. In AUMC cohort, PVC burden exceeding 0.5%, equal to about 3-4 beats per minute, is significantly associated with increased cardiac event risk, suggesting PVC's predictive power may rival that of NSVTs.

Volume

31

Issue

1

First Page

253

Last Page

254

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