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The prognostic significance of premature ventricular complexes in adults without clinically apparent heart disease: a meta-analysis and systematic review
  1. Victor Lee1,
  2. Harry Hemingway2,
  3. Rami Harb1,
  4. Tom Crake1,
  5. Pier Lambiase1
  1. 1Department of Cardiology, The Heart Hospital, University College London Hospital, London, UK
  2. 2Department of Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to Dr Victor Lee, Cardiology, The Heart Hospital, 16–18 Westmoreland Street, London W1G 8PH, UK; victorkflee{at}hotmail.com

Abstract

Aims Meta-analysis and systematic review to determine the long-term prognostic significance of premature ventricular complexes (PVCs) in adults without clinically apparent heart disease.

Methods Relevant studies were searched on MEDLINE and EMBASE. Inclusion criteria: controlled studies on adults without clinically apparent heart disease comparing the prognosis of the presence against the absence of PVCs. Endpoints: all-cause mortality, cardiovascular mortality, sudden cardiac death or development of ischaemic heart disease. OR of endpoints were analysed with random effects model. Relationships between study outcomes and study characteristics were assessed by meta-regression and sensitivity analysis.

Results Eight studies satisfied the inclusion criteria. Meta-analysis shows that in adults without clinically apparent heart disease, PVCs on ECG recording are associated with a pooled OR of 1.72 (95% CI 1.28 to 2.31) of endpoints compared with those without PVCs. However, only one study used echocardiogram or stress test to rule out heart disease. Meta-regression identified mean sample age (p=0.001), diabetes (p=0.005) and hypertension (p=0.005) as predictors of events. Only studies that used 100% male, not 100% female or mixed gender, found increased events.

Conclusions Most studies on PVC prognosis in ‘normal hearts’ did not use advanced tests to rule out structural heart disease. Among these patients, PVCs are associated with a worse cardiovascular outcome if patients are older and have higher cardiovascular risk, suggesting that the poor prognosis studies may have inadvertently included patients with occult structural heart disease, the population in which PVCs are known to confer adverse outcomes.

  • Meta-analysis
  • prognosis
  • premature ventricular complexes
  • without apparent heart disease
  • reperfusion
  • atherosclerosis
  • coronary collateral circulation
  • coronary flow

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Footnotes

  • There are no relationships with industry.

  • Funding This work is undertaken at UCLH/UCL which received a proportion of funding from the Department of Health's NIHR Biomedical Research Centres funding scheme. HH is supported by the National Institue for Health Research (RP-PG-0407-10314 Improving the quality of care for angina and heart attack), Wellcome Trust Fellowship (WT086091/Z/08/Z Higher resolution cardiovascular epidemiology), and the Medical Research Council (G0902393/99558) Partnership Prognosis Research Strategy (PROGRESS).

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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