Background Exercise testing is widely used in the diagnosisof coronary artery disease, but the long-term outcome for asymptomaticpersons with exercise-induced premature ventricular depolarizationsremains unclear. We used data from the Paris Prospective StudyI to assess the long-term outcome of such persons.
Methods A total of 6101 asymptomatic French men (42 to 53 yearsof age) who were free of clinically detectable cardiovasculardisease underwent a standardized graded exercise test between1967 and 1972. Subjects were prospectively classified as havingor not having frequent premature ventricular depolarizations(a run of two or more consecutive premature ventricular depolarizationsor premature ventricular depolarizations constituting more than10 percent of all ventricular depolarizations during any ofthe 30-second electrocardiographic recordings).
Results During exercise, 138 subjects had frequent prematureventricular depolarizations. After 23 years of follow-up, thesesubjects had a higher risk of death from cardiovascular causesthan the men without frequent premature ventricular depolarizationsduring exercise (relative risk, 2.67; 95 percent confidenceinterval, 1.76 to 4.07). In a multivariate model, with adjustmentfor standard coronary risk factors and the presence or absenceof premature ventricular depolarizations before exercise andduring recovery from exercise, both exercise-induced ischemiaand the occurrence of frequent premature ventricular depolarizationsduring exercise remained independently associated with an increasedrisk of death from cardiovascular causes, with similar relativerisks (2.63 [95 percent confidence interval, 1.93 to 3.59] and2.53 [95 percent confidence interval, 1.65 to 3.88], respectively).
Conclusions The occurrence of frequent premature ventriculardepolarizations during exercise in asymptomatic middle-agedmen is associated with a long-term increase in the risk of deathfrom cardiovascular causes.
Source Information
From the Service de Cardiologie, Université Paris V, Faculté Necker–Enfants Malades, Hôpital Européen Georges Pompidou, Paris (X.J., M.D.); and INSERM Unité 258 (Epidémiologie Cardiovasculaire et Métabolique), Hôpital Paul Brousse, Villejuif, France (X.J., M.Z., D.C., P.D.).
Address reprint requests to Dr. Jouven at the Service de Cardiologie, Hôpital Européen Georges Pompidou, 20 rue Le Blanc, 75015 Paris, France, or at xavier.jouven{at}bcc.ap-hop-paris.fr.
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