Thomas A Dewland, David G Rosenthal, Edward P Gerstenfeld, Melvin M Scheinman, Alvaro Alonso, Elsayed Z Soliman, Lin Yee Chen, David S Siscovick, Nona Sotoodehnia, John S Gottdiener, Bruce M Psaty, Susan R Heckbert, Phyllis K Stein, Gregory M Marcus
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Anatomical PVC location was assessed by 2 expert reviewers using baseline 12-lead electrocardiogram (ECG) morphology.</p><p><strong>Results: </strong>Among 20,590 participants, 427 (2.1%) demonstrated at least 1 PVC on baseline ECG. Ventricular ectopy was localized to the left ventricle in 49% of participants, outflow tract in 27%, right ventricle in 22%, and epicardium in 2%. Over a mean follow-up of 19.2 years, ventricular ectopy on baseline ECG was associated with an increased adjusted risk of heart failure (HR: 1.43; 95% CI: 1.20 to 1.70; P < 0.001). Adjusted risk of incident heart failure was highest for PVCs arising from the epicardium (HR: 2.98; 95% CI: 1.12 to 7.95; P = 0.029) and the left ventricle (HR: 1.59; 95% CI: 1.30 to 1.94; P < 0.001).</p><p><strong>Conclusions: </strong>In a large population-based cohort, ventricular ectopy was most frequently localized to the left ventricle. 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Anatomical PVC location was assessed by 2 expert reviewers using baseline 12-lead electrocardiogram (ECG) morphology.</p><p><strong>Results: </strong>Among 20,590 participants, 427 (2.1%) demonstrated at least 1 PVC on baseline ECG. Ventricular ectopy was localized to the left ventricle in 49% of participants, outflow tract in 27%, right ventricle in 22%, and epicardium in 2%. Over a mean follow-up of 19.2 years, ventricular ectopy on baseline ECG was associated with an increased adjusted risk of heart failure (HR: 1.43; 95% CI: 1.20 to 1.70; P < 0.001). Adjusted risk of incident heart failure was highest for PVCs arising from the epicardium (HR: 2.98; 95% CI: 1.12 to 7.95; P = 0.029) and the left ventricle (HR: 1.59; 95% CI: 1.30 to 1.94; P < 0.001).</p><p><strong>Conclusions: </strong>In a large population-based cohort, ventricular ectopy was most frequently localized to the left ventricle. 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引用次数: 0
摘要
背景：自发性室性异位的解剖分布以及与室性早搏（PVC）位置相关的心力衰竭风险，除了接受心律失常相关临床护理的狭窄人群外，尚未得到研究。目的：本研究旨在描述PVC起源部位的流行病学，并确定PVC解剖位置是否与发生心力衰竭的风险独立相关。方法：从CHS（心血管健康研究）和ARIC（社区动脉粥样硬化风险研究）队列中确定无普遍心力衰竭的门诊成年人。2位专家使用基线12导联心电图（ECG）形态学评估解剖性PVC位置。结果：在20,590名参与者中，427名（2.1%）在基线心电图上显示至少1例PVC。49%的参与者发生左心室异位，27%发生外流道，22%发生右心室，2%发生心外膜。在平均19.2年的随访中，基线心电图上的心室异位与心力衰竭调整风险增加相关（HR: 1.43; 95% CI: 1.20 ~ 1.70; P < 0.001）。心外膜（HR: 2.98; 95% CI: 1.12 ~ 7.95; P = 0.029）和左心室（HR: 1.59; 95% CI: 1.30 ~ 1.94; P < 0.001）引起的室性早搏发生心力衰竭的调整后风险最高。结论：在一个以人群为基础的队列中，心室异位最常局限于左心室。与没有室性早搏或其他部位室性早搏的患者相比，左心室和心外膜位置异位的患者发生心力衰竭的可能性更高。
Premature Ventricular Contraction Location and Incident Heart Failure.
Background: The anatomical distribution of spontaneous ventricular ectopy and the risk of heart failure associated with premature ventricular contraction (PVC) location has not been studied outside the narrow group of individuals presenting for arrhythmia-related clinical care.
Objectives: This study sought to describe the epidemiology of PVC site of origin and to determine whether PVC anatomical location is independently associated with incident heart failure risk.
Methods: Ambulatory adults without prevalent heart failure were identified from the CHS (Cardiovascular Health Study) and the ARIC (Atherosclerosis Risk in Communities Study) cohorts. Anatomical PVC location was assessed by 2 expert reviewers using baseline 12-lead electrocardiogram (ECG) morphology.
Results: Among 20,590 participants, 427 (2.1%) demonstrated at least 1 PVC on baseline ECG. Ventricular ectopy was localized to the left ventricle in 49% of participants, outflow tract in 27%, right ventricle in 22%, and epicardium in 2%. Over a mean follow-up of 19.2 years, ventricular ectopy on baseline ECG was associated with an increased adjusted risk of heart failure (HR: 1.43; 95% CI: 1.20 to 1.70; P < 0.001). Adjusted risk of incident heart failure was highest for PVCs arising from the epicardium (HR: 2.98; 95% CI: 1.12 to 7.95; P = 0.029) and the left ventricle (HR: 1.59; 95% CI: 1.30 to 1.94; P < 0.001).
Conclusions: In a large population-based cohort, ventricular ectopy was most frequently localized to the left ventricle. Individuals with ectopy arising from the left ventricle and from epicardial locations experienced a higher likelihood of incident heart failure compared with those without PVCs or those with PVCs from other locations.
期刊介绍：
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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