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HEART FAILURE

Severe frequent ventricular ectopy after exercise as a predictor of death in patients with heart failure

^* Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio

Manuscript received December 11, 2003; revised manuscript received February 11, 2004, ^* Reprint requests and correspondence: Dr. Michael S. Lauer, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Desk F25, 9500 Euclid Ave., Cleveland, OH 44195 (Email: lauerm{at}ccf.org).

OBJECTIVES: The study was done to determine the prognostic importance of frequent ventricular ectopy in recovery after exercise among patients with systolic heart failure (HF).

BACKGROUND: Although ventricular ectopy during recovery after exercise predicts death in patients without HF, its prognostic importance in patients with significant ventricular dysfunction is unknown.

METHODS: Systematic electrocardiographic data during rest, exercise, and recovery were gathered on 2,123 consecutive patients with left ventricular systolic ejection fraction 35% who were referred for symptom-limited metabolic treadmill exercise testing. Severe ventricular ectopy was defined as the presence of ventricular triplets, sustained or nonsustained ventricular tachycardia, ventricular flutter, polymorphic ventricular tachycardia, or ventricular fibrillation. The primary end point was all-cause mortality, with censoring for interval cardiac transplantation.

RESULTS: Of 2,123 patients, 140 (7%) had severe ventricular ectopy during recovery. There were 530 deaths (median follow-up among survivors 2.9 years). Severe ventricular ectopy during recovery was associated with an increased risk of death (three-year death rates 37% vs. 22%, hazard ratio [HR] 1.76; 95% confidence interval [CI] 1.32 to 2.34, p < 0.0001). After adjustment for ventricular ectopy at rest and during exercise, peak oxygen uptake, and other potential confounders, severe ventricular ectopy during recovery remained predictive of death (adjusted HR 1.48; 95% CI 1.10 to 1.97; p = 0.0089), whereas ventricular ectopy during exercise was not predictive of death in this cohort.

CONCLUSIONS: Severe ventricular ectopy during recovery after exercise is predictive of increased mortality in patients with severe HF and can be used as a prognostic indicator of adverse outcomes in HF cohorts.

Abbreviations and Acronyms   CI = confidence interval   HF = heart failure   HR = hazard ratio   LV = left ventricular   VCO2 = carbon dioxide production (in ml/kg/min)   VE = minute ventilation   VE/VCO2 = ratio of minute ventilation to carbon dioxide production   VO2 = oxygen consumption (in ml/kg/min)

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