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Previous Volume 348:781-790 February 27, 2003 Number 9 Next

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ABSTRACT

Background Exercise-induced ventricular ectopy predicts an increased risk of death in population-based cohorts. We sought to examine in a clinical cohort the prognostic importance of ventricular ectopy immediately after exercise, when reactivation of parasympathetic activity occurs. We hypothesized that ventricular ectopy after exercise (i.e., during the recovery phase) would predict an increased risk of death better than ventricular ectopy during exercise.

Methods We studied 29,244 patients (mean [±SD] age, 56±11 years; 70 percent men) who had been referred for symptom-limited exercise testing without a history of heart failure, valve disease, or arrhythmia. Frequent ventricular ectopy was defined by the presence of seven or more ventricular premature beats per minute, ventricular bigeminy or trigeminy, ventricular couplets or triplets, ventricular tachycardia, ventricular flutter, torsade de pointes, or ventricular fibrillation.

Results Frequent ventricular ectopy occurred only during exercise in 945 patients (3 percent), only during recovery in 589 (2 percent), and during both exercise and recovery in 491 (2 percent). There were 1862 deaths during a mean of 5.3 years of follow-up. Frequent ventricular ectopy during exercise predicted an increased risk of death (five-year death rate, 9 percent, vs. 5 percent among patients without frequent ventricular ectopy during exercise; hazard ratio, 1.8; 95 percent confidence interval, 1.5 to 2.1; P<0.001), but frequent ventricular ectopy during recovery was a stronger predictor (11 percent vs. 5 percent; hazard ratio, 2.4; 95 percent confidence interval, 2.0 to 2.9; P<0.001). After propensity matching for confounding variables, frequent ventricular ectopy during recovery predicted an increased risk of death (adjusted hazard ratio, 1.5; 95 percent confidence interval, 1.1 to 1.9; P=0.003), but frequent ventricular ectopy during exercise did not (adjusted hazard ratio, 1.1; 95 percent confidence interval, 0.9 to 1.3; P=0.53).

Conclusions Frequent ventricular ectopy during recovery after exercise is a better predictor of an increased risk of death than ventricular ectopy occurring only during exercise.

Source Information

From the Departments of General Internal Medicine (J.P.F.), Cardiovascular Medicine (C.E.P., M.S.L.), Cardiothoracic Surgery (E.H.B.), and Epidemiology and Biostatistics (E.H.B.), Cleveland Clinic Foundation, Cleveland.

Address reprint requests to Dr. Lauer at Desk F25, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, or at lauerm{at}ccf.org.

Full Text of this Article

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Ventricular Ectopy after Exercise as a Predictor of Death
Shah A. P., Rubin S. A., Gammenthaler S. A., Jouven X. P., Empana J.-P., Ducimetière P., Lauer M. S., Frolkis J. P., Blackstone E. H.
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N Engl J Med 2003; 348:2357-2359, Jun 5, 2003. Correspondence

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