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Are Exercise-Induced Premature Ventricular Contractions Associated with Significant Coronary Artery Disease?
Sok-Sithikun Bun1, Clementine Massimelli1, Didier Scarlatti1
1Faculty of Medicine, Pasteur University Hospital, 06000 Nice, France.
Insights
Exercise-induced premature ventricular contractions (EIPVC) are less linked to coronary artery disease (CAD) than exercise-induced ischemia. This study found significantly lower CAD prevalence in patients with EIPVC compared to those with ischemic exercise tests.
Area of Science:
- Cardiology
- Exercise Physiology
Background:
- Exercise-induced premature ventricular contractions (EIPVC) are linked to mortality, but their association with coronary artery disease (CAD) requires clarification.
- Understanding this link is crucial for risk stratification in patients with cardiovascular risk factors.
Purpose of the Study:
- To evaluate the association between EIPVC and significant underlying CAD in patients with cardiovascular risk factors.
- To compare the prevalence of CAD in patients with EIPVC versus those with exercise-induced ischemia.
Main Methods:
- Prospective study of patients over 35 undergoing exercise testing (ET) with cardiovascular risk factors and no known CAD.
- Patients were divided into Group A (EIPVC present) and Group B (ET showing ischemia).
- CAD was confirmed via coronary arteriography, scintigraphy, MRI, or CT angiography within two months post-ET.
Main Results:
- Of 4098 ETs, 46 patients had EIPVC (Group A) and 71 had exercise-induced ischemia (Group B).
- CAD was confirmed in 11% of Group A patients versus 54% of Group B patients (p < 0.0001).
- This indicates a significantly lower association between EIPVC and CAD compared to exercise-induced ischemia.
Conclusions:
- In patients without known CAD, EIPVC are less frequently associated with underlying CAD than exercise-induced "electrical" ischemia.
- Exercise-induced ischemia on ET is a stronger indicator of underlying CAD in this population.
- Further research may refine risk stratification strategies based on these findings.
Abstract:
Objectives: Exercise-induced premature ventricular contractions (EIPVC) have been associated with higher mortality, but the association with coronary artery disease (CAD) has not been precisely established. Our objective was to assess in a group of subjects with EIPVC and cardiovascular risk factors the association with underlying significant coronary artery disease (CAD), in comparison with a control group of patients with cardiovascular risk factors and exercise test (ET) showing ischaemia. Methods: All the patients (above 35 years old) referred for ET at our institution were prospectively included. Patients with at least one cardiovascular risk factor and without known CAD were divided into 2 groups: group A if EIPVC were present (either during exercise or during recovery), at least more than 10% over 30 s of recording; group B if ET was showing ischaemia. The presence of CAD was then confirmed in both groups by coronary arteriography, and/or thallium scintigraphy, and/or cardiac MRI and/or coronary CT angiography performed within 2 months after ET realization. Results: From November 2020 to December 2022, 4098 ETs were performed. After exclusion (normal ETs = 2194; known CAD = 1109; age < 35 years old = 487; congenital heart disease = 59; mitral valve prolapse = 4), 46 patients with EIPVC were finally identified (male 65%, mean age 61.5 ± 11 years), and 71 in group B. CAD was confirmed using additional tests in 5/46 (11%) patients in group A versus 38/71 (54%) in group B (p < 0.0001). Conclusions: Amongst patients without known CAD, the presence of EIPVC was less frequently associated with an underlying CAD, compared to the presence of exercise-induced "electrical" ischaemia.
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