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Association between extent of coronary artery disease and ventricular premature beat frequency after myocardial
A J Minisi1, J Mukharji, R B Rehr
1Department of Medicine, Medical College of Virginia, Richmond.
Insights
Frequent ventricular premature beats (VPBs) after myocardial infarction are linked to severe coronary artery disease (CAD). This association is independent of heart function, suggesting VPBs may indicate underlying ischemia.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Severe coronary artery disease (CAD) and frequent ventricular premature beats (VPBs) are known prognostic indicators post-myocardial infarction (MI).
- Understanding the relationship between CAD extent and VPB frequency is crucial for patient risk stratification.
Purpose of the Study:
- To investigate the correlation between the severity of coronary artery disease and the frequency of ventricular premature beats in patients surviving myocardial infarction.
- To determine if VPB frequency is an independent predictor of CAD extent, separate from left ventricular ejection fraction.
Main Methods:
- 128 patients surviving myocardial infarction underwent 24-hour ECG monitoring, coronary angiography, and left ventriculography.
- Coronary artery disease was assessed by vessel count and a validated jeopardy score.
- Multivariate ordinal logistic regression analysis was employed to evaluate independent associations.
Main Results:
- A significant positive correlation was observed between VPB frequency and the extent of CAD (assessed by vessel count and jeopardy score).
- Frequent VPBs (median 6/hr) were significantly associated with three-vessel CAD compared to one- or two-vessel disease (p < 0.01).
- VPB frequency and left ventricular ejection fraction independently predicted CAD severity.
Conclusions:
- Frequent ventricular premature beats following myocardial infarction are significantly associated with extensive coronary artery disease.
- The prognostic value of frequent VPBs may stem from their association with severe underlying ischemic heart disease.
- VPB frequency is an independent predictor of CAD extent, irrespective of left ventricular ejection fraction.
Abstract:
Severe coronary artery disease (CAD) and frequent ventricular premature beats (VPBs) on ambulatory ECG monitoring in the late hospital phase after myocardial infarction are independent predictors of prognosis. To study the relationship between extent of CAD and VPB frequency, 128 consecutive (91 men, 37 women) patients surviving 6 days after myocardial infarction underwent 24-hour ECG, coronary angiography, and left ventriculography. CAD was graded as zero to one-, two-, and three-vessel (V), and also by a previously validated "jeopardy score" with 0 to 12 as grades of incremental CAD severity. Average VPB frequency was significantly correlated with CAD by V, CAD by jeopardy score, and by left ventricular ejection fraction (p less than 0.01 for all three). With the use of a multivariate ordinal logistic regression model, both VPB frequency and left ventricular ejection fraction were found to have independent association with CAD. The median VPB frequency was 1/hr, 0.6/hr, and 6/hr in zero to one-, two-, and three-V CAD, respectively (zero to one- and two-V CAD vs three-V CAD p less than 0.01, one-V CAD vs two-V CAD p = NS). In conclusion, frequent VPBs following myocardial infarction are associated with extensive CAD and are independent of left ventricular ejection fraction. Therefore, the prognostic value of frequent VPBs may be related to severe underlying ischemic disease.