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Functional significance of premature ventricular complex morphology evaluated during treadmill exercise stress test
E Antunes1, A Galrinho, R Ferreira
1Department of Cardiology, Santa Marta Hospital, Lisbon, Portugal.
Insights
Premature ventricular complexes (PVC) morphology during exercise stress tests can indicate left ventricular systolic dysfunction in coronary artery disease patients. Wider notching in PVCs correlates with reduced ejection fraction and higher rates of ventricular aneurysm and mitral regurgitation.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Cardiovascular Imaging
Background:
- Coronary artery disease (CAD) is a leading cause of cardiovascular morbidity.
- Premature ventricular complexes (PVCs) are common in patients with CAD.
- The prognostic significance of PVC morphology in CAD requires further elucidation.
Purpose of the Study:
- To investigate the relationship between PVC morphology during exercise stress testing and left ventricular (LV) systolic function in patients with established CAD.
- To determine if specific PVC morphological characteristics are associated with impaired LV myocardial systolic function.
Main Methods:
- A retrospective analysis of 112 patients with proven CAD was conducted.
- Thirty-three patients with PVCs during treadmill exercise stress testing were categorized into two groups based on PVC morphology (Type I: narrow notching < 40 ms; Type II: wide notching > 40 ms).
- Ejection fraction, QRS duration, exercise duration, metabolic units, and prevalence of ventricular aneurysm and mitral regurgitation were assessed.
Main Results:
- Significant differences in mean ejection fraction were observed between Type I (59.2%) and Type II (48.6%) PVC groups (p < 0.05).
- Patients with Type II PVCs exhibited a higher prevalence of ventricular aneurysm (30% vs 10%) and mitral regurgitation compared to Type I PVCs.
- These findings suggest a correlation between specific PVC morphologies and indicators of cardiac dysfunction.
Conclusions:
- Specific morphological characteristics of PVCs identified during exercise stress testing in CAD patients may signify underlying left ventricular myocardial systolic dysfunction.
- Type II PVCs, characterized by wide notching, are associated with poorer LV systolic function and increased risk of structural heart abnormalities.
- PVC morphology could serve as a non-invasive marker for assessing LV systolic function in patients with coronary artery disease.
Objectives:
To evaluate the relation between premature ventricular complexes morphology and left ventricular myocardial systolic function in patients with proved coronary artery disease.
Setting:
Department of Cardiology at General Hospital.
Methods:
From 112 patients (pts) with proved coronary artery disease, thirty-three pts with premature ventricular complexes (PVC) detected during treadmill exercise stress test were selected. Two groups of pts were considered: group I-20 pts with regular contour or with a narrow notching (< 40 ms; type I PVC) and group II-13 patients with wide notching (> 40 ms; type II PVC). In each group the following parameters were studied: ejection fraction, QRS duration, duration of exercise, number of metabolic units and the prevalence of ventricular aneurysm and mitral regurgitation.
Results:
Statistical significant differences were found between group I and II concerning the mean ejection fraction (59.2% vs 48.6%; p < 0.05). The prevalence of ventricular aneurysm and mitral regurgitation was higher in patients with type II ventricular premature complexes (10% vs 30%).
Conclusion:
Particular characteristics of premature ventricular complexes detected during treadmill exercise stress test, in patients with proved coronary artery disease, suggest the presence of left ventricular myocardial systolic dysfunction.