Association Between Left Ventricular Function and Recurrent Premature Ventricular Contractions in Patients Referred to Baqiyatullah Hospital

Document Type : Original Article

Authors

1 Atherosclerosis Research Center, Clinical Sciences Institute, Baqiyatullah University of Medical Sciences, Tehran, IR Iran.

2 Baqiyatullah University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Premature ventricular contractions (PVCs) cause left ventricular (LV) dysfunction and may lead to premature ventricular contraction-induced cardiomyopathy (PVC-CM). Evaluation of left ventricular ejection fraction (LVEF) using 2D transthoracic echocardiography allows PVC-CM diagnosis only in the later stages. Therefore, this study aimed to investigate the association between left ventricular global longitudinal strain (LVGLS) and PVCs.
 
Methods: We assessed 53 patients admitted to Baqiyatullah Hospital with complaints of heart palpitations. These patients, who had normal LVEF and PVCs between 5000 and 10,000 based on ECG underwent LVGLS evaluation by echocardiography. Then, their LV strain values were compared with those of a corresponding control group.
 
Results: The patient and control groups were well-matched concerning age, sex, and LVEF and had no significant differences. LVGLS was significantly lower in the patient group. ROC curve evaluation showed an acceptable diagnostic value for LVGLS regarding PVCs (AUC, 0.82; P=0.0001), with a sensitivity of 71.7% and a specificity of 84.9%.
 
Conclusions: Recurrent PVCs may cause LV dysfunction and CM independently of any underlying heart disease, despite a normal LVEF. Early detection of subtle ventricular dysfunction can be achieved with speckle-tracking echocardiographic methods other than conventional echocardiographic procedures. The former methods are, therefore, valuable as a critical adjunct in systolic function assessment. (Iranian Heart Journal 2024; 25(2): 56-64)

Keywords

References

  1. Koester C, Ibrahim AM, Cancel M, Labedi MR. The ubiquitous premature ventricular complex. Cureus. 2020;12(1).
  2. Ng GA. Treating patients with ventricular ectopic beats. Heart. 2006;92(11):1707-12.
  3. Bogun F, Crawford T, Reich S, Koelling TM, Armstrong W, Good E, et al. Radiofrequency ablation of frequent, idiopathic premature ventricular complexes: comparison with a control group without intervention. Heart rhythm. 2007;4(7):863-7.
  4. Chugh SS, SHEN WK, Luria DM, Smith HC. First evidence of premature ventricular complex‐induced cardiomyopathy: a potentially reversible cause of heart failure. Journal of cardiovascular electrophysiology. 2000;11(3):328-9.
  5. Duffee DF, Shen WK, Smith HC. Suppression of frequent premature ventricular contractions and improvement of left ventricular function in patients with presumed idiopathic dilated cardiomyopathy. Mayo Clin Proc. 1998;73(5):430-3. eng. [PubMed ID:9581582]. https://doi.org/10.1016/s0025-6196(11)63724-5.
  6. ten Cate FEU, Kruessell MA, Wagner K, Trieschmann U, Emmel M, Brockmeier K, et al. Dilated cardiomyopathy in children with ventricular preexcitation: the location of the accessory pathway is predictive of this association. Journal of Electrocardiology. 2010;43(2):146-54.
  7. van Geldorp IE, Delhaas T, Gebauer RA, Frias P, Tomaske M, Friedberg MK, et al. Impact of the permanent ventricular pacing site on left ventricular function in children: a retrospective multicentre survey. Heart. 2011;97(24):2051-5. eng. [PubMed ID:21917655]. https://doi.org/10.1136/heartjnl-2011-300197.
  8. Wang J-s, Shen Y-g, Yin R-p, Thapa S, Peng Y-p, Ji K-t, et al. The safety of catheter ablation for premature ventricular contractions in patients without structural heart disease. BMC cardiovascular disorders. 2018;18(1):1-6.
  9. Baman TS, Lange DC, Ilg KJ, Gupta SK, Liu T-Y, Alguire C, et al. Relationship between burden of premature ventricular complexes and left ventricular function. Heart rhythm. 2010;7(7):865-9.
  10. Hasdemir C, Ulucan C, Yavuzgil O, Yuksel A, Kartal Y, Simsek E, et al. Tachycardia‐induced cardiomyopathy in patients with idiopathic ventricular arrhythmias: the incidence, clinical and electrophysiologic characteristics, and the predictors. Journal of cardiovascular electrophysiology. 2011;22(6):663-8.
  11. Takemoto M, Yoshimura H, Ohba Y, Matsumoto Y, Yamamoto U, Mohri M, et al. Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease. Journal of the American College of Cardiology. 2005;45(8):1259-65.
  12. Ip JE, Lerman BB. Idiopathic malignant premature ventricular contractions. Trends in Cardiovascular Medicine. 2018;28(4):295-302.
  13. Kanat S, Mutluer FO, Tütüncü A, Duran Karaduman B, Bozkaya VO, Keskin M, et al. Left atrial function is improved in short-term follow-up after catheter ablation of outflow tract premature ventricular complexes. Medicina. 2019;55(6):241.
  14. Mutluer FO, Canpolat U, Yap S-C. Premature ventricular contraction–induced cardiomyopathy entails more than only systolic left ventricular dysfunction. Heart. 2020;106(2):164-.
  15. Wijnmaalen AP, Delgado V, Schalij MJ, van Huls van Taxis CF, Holman ER, Bax JJ, et al. Beneficial effects of catheter ablation on left ventricular and right ventricular function in patients with frequent premature ventricular contractions and preserved ejection fraction. Heart. 2010;96(16):1275-80. eng. [PubMed ID:20659945]. https://doi.org/10.1136/hrt.2009.188722.
  16. Latchamsetty R, Bogun F. Premature Ventricular Complex-induced Cardiomyopathy. Rev Esp Cardiol (Engl Ed). 2016;69(4):365-9. eng. [PubMed ID:26935453]. https://doi.org/10.1016/j.rec.2015.12.015.
  17. Sekiguchi Y, Aonuma K, Yamauchi Y, Obayashi T, Niwa A, Hachiya H, et al. Chronic hemodynamic effects after radiofrequency catheter ablation of frequent monomorphic ventricular premature beats. Journal of cardiovascular electrophysiology. 2005;16(10):1057-63.
  18. Takahashi S, Mine T, Ashida K, Kishima H, Masuyama T, Ishihara M. Left Ventricular Inflow Velocity Pattern in Patients With Symptomatic Premature Ventricular Contraction. Circ J. 2019;84(1):26-32. eng. [PubMed ID:31801920]. https://doi.org/10.1253/circj.CJ-19-0605.
  19. Walia R, Chang SL, Lin YJ, Lo LW, Hu YF, Chao TF, et al. Early detection of electromechanical dysfunction in patients with idiopathic premature ventricular contractions. Pacing and Clinical Electrophysiology. 2019;42(6):637-45.
  20. Cantinotti M, Kutty S, Giordano R, Assanta N, Murzi B, Crocetti M, et al. Review and status report of pediatric left ventricular systolic strain and strain rate nomograms. Heart failure reviews. 2015;20:601-12.
  21. Gunasekaran P, Panaich S, Briasoulis A, Cardozo S, Afonso L. Incremental value of two dimensional speckle tracking echocardiography in the functional assessment and characterization of subclinical left ventricular dysfunction. Current cardiology reviews. 2017;13(1):32-40.
  22. Shahul S, Gulati G, Hacker MR, Mahmood F, Canelli R, Nizamuddin J, et al. Detection of myocardial dysfunction in septic shock: a speckle-tracking echocardiography study. Anesthesia & Analgesia. 2015;121(6):1547-54.
  23. Deyell MW, Park K-M, Han Y, Frankel DS, Dixit S, Cooper JM, et al. Predictors of recovery of left ventricular dysfunction after ablation of frequent ventricular premature depolarizations. Heart rhythm. 2012;9(9):1465-72.
  24. Lee AK, Deyell MW. Premature ventricular contraction-induced cardiomyopathy. Current Opinion in Cardiology. 2016;31(1):1-10.
  25. Zhong L, Lee Y-H, Huang X-M, Asirvatham SJ, Shen W-K, Friedman PA, et al. Relative efficacy of catheter ablation vs antiarrhythmic drugs in treating premature ventricular contractions: a single-center retrospective study. Heart rhythm. 2014;11(2):187-93.
  26. Lie ØH, Saberniak J, Dejgaard LA, Stokke MK, Hegbom F, Anfinsen OG, et al. Lower than expected burden of premature ventricular contractions impairs myocardial function. ESC heart failure. 2017;4(4):585-94.
  27. Akam-Venkata J, Kadiu G, Galas J, Lipshultz SE, Aggarwal S. Left ventricle segmental function in childhood cancer survivors using speckle-tracking echocardiography. Cardiology in the Young. 2019;29(12):1494-500.
  28. Amedro P, Vincenti M, De La Villeon G, Lavastre K, Barrea C, Guillaumont S, et al. Speckle-tracking echocardiography in children with Duchenne muscular dystrophy: a prospective multicenter controlled cross-sectional study. Journal of the American Society of Echocardiography. 2019;32(3):412-22.
  29. Dasgupta S, Madani R, Figueroa J, Cox D, Ferguson E, Border W, et al. Myocardial deformation as a predictor of right ventricular pacing‐induced cardiomyopathy in the pediatric population. Journal of Cardiovascular Electrophysiology. 2020;31(1):337-44.
  30. El Razaky O, El Amrousy D, Elrifaey S, Elgendy M, Ibrahim W. Three‐dimensional speckle tracking echocardiography: Is it the magic wand in the diagnosis of subclinical myocardial dysfunction in children with type 1 diabetes mellitus? Echocardiography. 2018;35(10):1657-63.
  31. Park KM, Im SI, Park SJ, Kim JS, On YK. Risk factor algorithm used to predict frequent premature ventricular contraction-induced cardiomyopathy. Int J Cardiol. 2017;233:37-42. eng. [PubMed ID:28188001]. https://doi.org/10.1016/j.ijcard.2017.02.007.
  32. Koca H, Koca F, Icen YK, Demirtas AO, Aslan MZ, Sumbul HE, et al. Impaired left ventricular global longitudinal strain improves with radiofrequency catheter ablation in patients with PVC‐induced cardiomyopathy. Pacing and Clinical Electrophysiology. 2020;43(9):947-57.
  33. Uhm JS, Ko KY, Shim CY, Park JW, Kim M, Bae S, et al. Effects of radiofrequency catheter ablation for premature ventricular complexes originating from the right ventricular outflow tract on right ventricular function. Journal of Cardiovascular Electrophysiology. 2023;34(1):189-96.
  34. Alhede C, Higuchi S, Hadjis A, Bibby D, Abraham T, Schiller NB, et al. Premature ventricular contractions are presaged by a mechanically abnormal sinus beat. Clinical Electrophysiology. 2022;8(8):943-53.
  35. Doğan Z, Erden EÇ, ERDEN İ, Bektaşoğlu G. Assessment of subtle cardiac dysfunction induced by premature ventricular contraction using two dimensional strain echocardiography and the effects of successful ablation. 2023.
  36. Ban J-E, Park H-C, Park J-S, Nagamoto Y, Choi J-I, Lim H-E, et al. Electrocardiographic and electrophysiological characteristics of premature ventricular complexes associated with left ventricular dysfunction in patients without structural heart disease. Europace. 2013;15(5):735-41.
  37. Yarlagadda RK, Iwai S, Stein KM, Markowitz SM, Shah BK, Cheung JW, et al. Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract. Circulation. 2005;112(8):1092-7.
  38. Allam SR, Sami M, Azzam MI. ‌ Assessment of the effects of frequent ventricular extra systoles on the left ventricle function using two-dimensional speckle tracking echocardiography in apparently normal hearts. The Egyptian Journal of Hospital Medicine. 2019;74(1):170-6.
  39. DEL CARPIO MUNOZ F, Syed FF, Noheria A, CHA YM, Friedman PA, Hammill SC, et al. Characteristics of premature ventricular complexes as correlates of reduced left ventricular systolic function: study of the burden, duration, coupling interval, morphology and site of origin of PVCs. Journal of cardiovascular electrophysiology. 2011;22(7):791-8.
  40. Lin C-Y, Chang S-L, Lin Y-J, Lo L-W, Chung F-P, Chen Y-Y, et al. Long-term outcome of multiform premature ventricular complexes in structurally normal heart. International Journal of Cardiology. 2015;180:80-5.
  41. Winkens R, Höppener P, Kragten J, Verburg M, Crebolder H. Are premature ventricular contractions always harmless? The European Journal of General Practice. 2014;20(2):134-8.
  42. Cha Y-M, Lee GK, Klarich KW, Grogan M. Premature ventricular contraction-induced cardiomyopathy: a treatable condition. Circulation: Arrhythmia and Electrophysiology. 2012;5(1):229-36.
Iranian Heart Journal
Volume 25, Issue 2
March 2024
Pages 56-64

Files

Share

How to cite

Statistics