Impact of Premature Ventricular Complex Burden on Ischemic Stroke in Patients with Non-Valvular Atrial Fibrillation
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Data Collection and Study Outcomes
2.3. Statistical Analysis
3. Results
3.1. PVC Burden and Baseline Characteristics
3.2. Echocardiographic Parameters According to PVC Burden
3.3. Clinical Outcomes according to PVC Burden
4. Discussion
4.1. PVC Burden and Stroke in Patients with AF
4.2. Study Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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PVC Burden ≥ 10% | PVC Burden < 10% | p Value | |
---|---|---|---|
N = 120 (2.5) | N = 4714 (97.5) | ||
Demographics | |||
Age, years | 64.1 ± 13.1 | 62.2 ± 12.9 | 0.113 |
Male sex | 71 (59.2) | 3221 (68.3) | 0.043 |
Cardiovascular risk factors | |||
Diabetes mellitus | 17 (14.2) | 392 (8.3) | 0.035 |
Hypertension | 54 (45.0%) | 1054 (22.4) | <0.001 |
Chronic kidney disease | 5 (4.2) | 128 (2.7) | 0.498 |
Peripheral vascular disease | 1 (0.8) | 55 (1.2) | 1.000 |
Previous myocardial infarction | 12 (10.0) | 147 (3.1) | <0.001 |
Heart failure | 22 (18.3) | 235 (5.0) | <0.001 |
CHA2DS2–VASc score | 2.2 ± 1.4 | 1.3 ± 1.3 | <0.001 |
Type of AF | 0.993 | ||
Paroxysmal | 104 (86.7) | 4064 (86.2) | |
Persistent | 16 (13.3) | 650 (13.8) | |
Antiarrhythmic agent usage | |||
Class Ic | 30 (25.0) | 1169 (24.8) | 1.000 |
Class III | 43 (35.8) | 1220 (25.9) | 0.019 |
Beta blocker | 65 (54.2) | 1918 (40.7) | 0.004 |
Calcium channel blocker | 12 (10.0) | 704 (14.9) | 0.170 |
PVC burden during 24 h | 21.8 ± 13.8 | 0.3 ± 1.1 | <0.001 |
PVC type | N = 120 | N = 560 | 0.781 |
Idiopathic | 95 (79.2) | 469 (83.8) | |
RVOT | 35 (29.2) | 177 (31.6) | |
LVOT | 34 (28.3) | 157 (28.0) | |
Non-OT | 26 (21.7) | 135 (24.1) | |
Structural heart disease | 25 (20.8) | 91 (16.3) | |
Non-ischemic | 16 (13.3) | 61 (10.9) | |
Ischemic | 9 (7.5) | 30 (5.4) |
PVC Burden ≥ 10% | PVC Burden < 10% | p Value | |
---|---|---|---|
N = 120 (2.5) | N = 4714 (97.5) | ||
Baseline echocardiogram | |||
LV ejection fraction (%) | 57.9 ± 10.9 | 61.2 ± 9.2 | 0.004 |
LA volume index (mL/m2) | 47.4 ± 20.2 | 44.8 ± 19.6 | 0.196 |
LA diameter (mm) | 44.1 ± 7.7 | 42.7 ± 7.9 | 0.064 |
RV systolic pressure (mmHg) | 30.0 ± 8.7 | 28.4 ± 7.9 | 0.091 |
E/e’ | 11.1 ± 4.7 | 10.1 ± 5.1 | 0.084 |
Follow-Up echocardiogram | |||
Time to follow-up echocardiogram (day) | 1179 (533–2226) | 1095 (261–2078) | 0.242 |
LV ejection fraction (%) | 55.3 ± 13.8 | 61.2 ± 8.7 | <0.001 |
LA volume index (mL/m2) | 51.9 ± 24.5 | 46.8 ± 21.5 | 0.025 |
LA diameter (mm) | 45.5 ± 7.7 | 43.0 ± 8.0 | 0.003 |
RV systolic pressure (mmHg) | 31.2 ± 8.3 | 29.1 ± 8.7 | 0.042 |
E/e’ | 13.0 ± 7.8 | 10.5 ± 5.5 | 0.004 |
ΔLV ejection fraction from baseline (%) | −1.8 (−9.0–4.0) | 0.0 (−6.0–6.0) | 0.038 |
ΔLA volume index from baseline (mL/m2) | 5.8 (−1.5–13.8) | 2.0 (−6.3–11.6) | 0.039 |
ΔLA diameter from baseline (mm) | 2.8 (−1.6–5.1) | 0.4 (−3.1–4.0) | 0.036 |
ΔRV systolic pressure from baseline (mmHg) | 0.2 (0.0–3.8) | 0.0 (−0.2–2.8) | 0.227 |
ΔE/e’ from baseline | 1.0 (−0.5–4.2) | 0.3 (−1.7–2.4) | 0.036 |
PVC Burden ≥ 10% | PVC Burden < 10% | Univariable HR (95% CI) | Multivariable HR (95% CI) * | p Value | |
---|---|---|---|---|---|
N = 120 | N = 4714 | ||||
Ischemic stroke | 19 (21.8%) | 304 (9.3%) | 2.469 (1.553–3.952) | 2.332 (1.179–4.614) | 0.015 |
Embolic stroke | 17 (20.1%) | 229 (7.0%) | 2.937 (1.794–4.807) | 3.370 (1.606–7.071) | 0.001 |
Thrombotic stroke | 2 (2.2%) | 75 (2.5%) | 1.048 (0.257–4.269) | 1.111 (0.271–4.561) | 0.883 |
Cardiac death | 3 (3.1%) | 82 (3.4%) | 1.399 (0.442–4.429) | 0.903 (0.284–2.873) | 0.862 |
HF admission | 18 (28.4%) | 253 (15.7%) | 2.733 (1.694–4.409) | 2.147 (1.197–3.848) | 0.010 |
Variable | Univariate Analysis | Multivariate Analysis * | ||
---|---|---|---|---|
HR (95% CI) | p Value | HR (95% CI) | p Value | |
PVC burden ≥ 10% | 2.469 (1.553–3.952) | <0.001 | 3.508 (1.671–7.363) | <0.001 |
CHA2DS2–VASc score, per 1 score increase | 1.321 (1.227–1.423) | <0.001 | 1.488 (1.132–1.957) | 0.004 |
Persistent AF | 2.253 (1.738–2.921) | <0.001 | 3.467 (0.932–12.899) | 0.064 |
Antiarrhythmic agent usage | 0.910 (0.720–1.150) | 0.427 | 0.607 (0.284–1.299) | 0.199 |
PVC location (non-OT) | 0.933 (0.646–1.348) | 0.713 | 1.193 (0.761–1.872) | 0.441 |
LV ejection fraction, per 1% increase | 0.994 (0.983–1.006) | 0.335 | 1.021 (0.980–1.065) | 0.320 |
LA volume index, per 1 mL/m2 increase | 1.011 (1.006–1.016) | <0.001 | 1.009 (0.987–1.033) | 0.413 |
E/e’, per 1 increase | 1.030 (1.014–1.046) | <0.001 | 1.010 (0.919–1.110) | 0.830 |
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Kim, J.; Kim, J.Y.; Park, S.-J.; On, Y.K.; Park, K.-M. Impact of Premature Ventricular Complex Burden on Ischemic Stroke in Patients with Non-Valvular Atrial Fibrillation. J. Clin. Med. 2024, 13, 5009. https://doi.org/10.3390/jcm13175009
Kim J, Kim JY, Park S-J, On YK, Park K-M. Impact of Premature Ventricular Complex Burden on Ischemic Stroke in Patients with Non-Valvular Atrial Fibrillation. Journal of Clinical Medicine. 2024; 13(17):5009. https://doi.org/10.3390/jcm13175009
Chicago/Turabian StyleKim, Juwon, Ju Youn Kim, Seung-Jung Park, Young Keun On, and Kyoung-Min Park. 2024. "Impact of Premature Ventricular Complex Burden on Ischemic Stroke in Patients with Non-Valvular Atrial Fibrillation" Journal of Clinical Medicine 13, no. 17: 5009. https://doi.org/10.3390/jcm13175009