Association of frequent premature ventricular complex >10% and stroke-like symptoms without a prior diagnosis of stroke or transient ischemic attack

Abstract

IntroductionPremature ventricular complex (PVCs) detected from long-term ECG recordings have been associated with an increased risk of ischemic stroke. However, there was limited data about the association between high PVCs burdens (>10%) and stroke-like symptoms without a prior diagnosis of stroke or transient ischemic attack in the long-term follow up.MethodsThe Kosin University 24-hours holter monitoring, echocardiography, electrocardiogram (ECG) database were reviewed from 2013 to 2015 to identify patients with frequent PVCs (>10%). We compared the long-term clinical outcomes between the patients with frequent PVCs (>10%) and control group without PVC.ResultsAmong 572 patients who underwent 24-hours holter monitoring, finally, 373 consecutive patients (mean age; 59.5 ± 15.8 years, 45.2% male) were enrolled. Among them, 203(54.4%) patients had high PVCs burdens (>10%). There was no difference of the baseline characteristics. In the long term follow-up, PVCs burden was not associated with PVCs -related symptoms (P = 0.210). In univariate analysis, female, non-sustained ventricular tachycardia (VT), sinus QRS duration, PVC coupling interval (CI), post- PVC CI, and late precordial R-wave transition of PVCs were associated with PVCs-related symptoms. In multivariate analysis, non-sustained VT (P = 0.022) and late precordial R-wave transition of PVCs (P = 0.044) were independent risk factors for PVCs-related stroke-like symptoms with frequent idiopathic PVCs > 10%.ConclusionHigh PVCs burdens (>10%) were associated with and stroke-like symptoms without a prior diagnosis of stroke or transient ischemic attack in the long-term follow up, suggesting more intensive medical therapy with close clinical follow-up will be required.

Association of premature ventricular complexes and risk of ischemic stroke: A systematic review and meta‐analysis

“…A total of 57 articles were retrieved for full‐length article review and 53 articles were excluded at this stage as they did not report the association of interest. Finally, four cohort studies 7,15‐17 with 42 677 participants (4651 patients had PVCs) were eligible for the meta‐analysis. The literature retrieval, review, and selection process are shown in Figure 1.…”

“…A total of four studies reported on the risk of ischemic stroke among patients with PVCs 7,15‐17 . The pooled analysis found a significantly increased risk of ischemic stroke among patients with PVCs compared to individuals without PVCs with the pooled RR of 1.31 (95% CI, 1.07–1.60).…”

“…The second explanation is the increased risk of subsequent AF, the prime predisposing of thromboembolic events 7,17,26,31 . Frequent PVCs may not only lead to ventricular cardiomyopathy but also atrial cardiomyopathy as well.…”

“…Thus, it could not draw the exact association between PVCs, AF, and ischemic stroke. On the other hand, most studies just reported the incidence of new‐onset AF at the end of follow‐up 7,17,26,31 …”

“…The difference in PVCs burden across the included studies was the most likely explanation for the heterogeneity as demonstrated by the sensitivity analysis. Secondly, most of the included studies used the different measurement methods to detect and diagnose PVCs: 2‐minute ECG was used in 1 study, 15 routine ECG in 1 study, 16 and 24‐hour Holter monitoring in 2 studies 7,17 . Therefore, the accuracy of the diagnoses from those studies was relatively limited.…”