Clinical and electrocardiographic predictors of left ventricular diastolic dysfunction in patients with idiopathic premature ventricular contractions

Year 2024, EARLY ONLINE, 1 - 8

Onur Kaypaklı , Fatma Özge Salkın

https://doi.org/10.18621/eurj.1540136

Abstract

Objectives: Tachycardiomyopathy is a well-known phenomenon with reduction in left ventricular (LV) systolic function. In our study, we aimed to investigate the effects of idiopathic premature ventricular contractions (PVCs) on LV diastolic function in patients with idiopathic PVCs.

Methods: We included 63 patients who are candidates to undergo radiofrequency ablation due to idiopathic PVCs (27 male, 36 female; mean age 47.9 ±16.6 years). Patients were classified into two groups according to the presence of LV diastolic dysfunction. The percentage of PVC burden was calculated by dividing the daily PVC burden by the total heart beat per day. Coupling interval ratio was calculated with the formula of Coupling interval ratio = (Coupling interval/sinus cycle length)x100.

Results: Age, presence of q wave in D2-D3, daily PVC burden, percentage of PVC burden, left atrial volume index, intervenricular septum thickness, and mitral E/e’ ratio were significantly higher; male gender, peak E-wave velocity, lateral and septal annular e' velocity were significantly lower in patients with LV diastolic dysfunction. Daily PVC burden and percentage of PVC burden were positively correlated with mitral E/e’ ratio and negatively correlated with lateral annular e' velocity. The coupling interval ratio was positively correlated with mitral E/e’ ratio. Age, daily PVC burden, and percentage of PVC burden were independent predictors of increased mitral E/e’ ratio. The cutoff value of the percentage of PVC burden was 15.59% for prediction of LV diastolic dysfunction (sensitivity: 88.9%, specificity: 66.7%).

Conclusions: Daily PVC burden, percentage of PVC burden, and coupling interval ratio are correlated with echocardiographic parameters of LV diastolic function.

Keywords

Premature ventricular contractions, coupling interval ratio, left ventricular diastolic function

References

• 1. Crosson JE, Callans DJ, Bradley DJ, et al. PACES/HRS expert consensus statement on the evaluation and management of ventricular arrhythmias in the child with a structurally normal heart. Heart Rhythm. 2014;11(9):e55-78. doi: 10.1016/j.hrthm.2014.05.010.
• 2. Del Carpio Munoz F, Syed FF, Noheria A, 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. J Cardiovasc Electrophysiol. 2011;22(7):791-798. doi: 10.1111/j.1540-8167.2011.02021.x.
• 3. Ban JE, Park HC, Park JS, 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):735-741. doi: 10.1093/europace/eus371.
• 4. Abadir S, Blanchet C, Fournier A, et al. Characteristics of premature ventricular contractions in healthy children and their impact on left ventricular function. Heart Rhythm. 2016;13(11):2144-2148. doi: 10.1016/j.hrthm.2016.07.002.
• 5. Pietrzak R, Książczyk TM, Franke M, Werner B. Diastolic function evaluation in children with ventricular arrhythmia. Sci Rep. 2023;13(1):5897. doi: 10.1038/s41598-023-33118-x.
• 6. Salem AS, Elkotby MA, Nasr GM, Abdellah AT. Association of premature ventricular complex burden with elevated left ventricular filling pressure. Cardiovasc J Afr. 2021;32(5):248-253. doi: 10.5830/CVJA-2021-021.
• 7. Topaloglu S, Aras D, Cagli K, et al. Evaluation of left ventricular diastolic functions in patients with frequent premature ventricular contractions from right ventricular outflow tract. Heart Vessels. 2007;22(5):328-334. doi: 10.1007/s00380-007-0978-9.
• 8. Lee PT, Huang MH, Huang TC, Hsu CH, Lin SH, Liu PY. High Burden of Premature Ventricular Complex Increases the Risk of New-Onset Atrial Fibrillation. J Am Heart Assoc. 2023;12(4):e027674. doi: 10.1161/JAHA.122.027674.
• 9. Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019;32(1):1-64. doi: 10.1161/JAHA.122.027674.
• 10. Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29(4):277-314. doi: 10.1016/j.echo.2016.01.011.
• 11. Park KM, Im SI, Chun KJ, et al. Coupling Interval Ratio Is Associated with Ventricular Premature Complex-Related Symptoms. Korean Circ J. 2015;45(4):294-300. doi: 10.4070/kcj.2015.45.4.294.
• 12. Lee PT, Huang TC, Huang MH, et al. The Burden of Ventricular Premature Complex Is Associated With Cardiovascular Mortality. Front Cardiovasc Med. 2022;8:797976. doi: 10.3389/fcvm.2021.797976.
• 13. Lee YH, Zhong L, Roger VL, et al. Frequency, origin, and outcome of ventricular premature complexes in patients with or without heart diseases. Am J Cardiol. 2014;114(9):1373-1378. doi: 10.1016/j.amjcard.2014.07.072.
• 14. Peinado R, Merino JL, Gnoatto M, Arias MA. Atrial fibrillation triggered by postinfarction ventricular premature beats in a patient with Wolff-Parkinson-White syndrome. Europace. 2005;7(3):221-224. doi: 10.1016/j.eupc.2004.12.003.
• 15. Friedman DJ, Chasten T, Anderson K, Mullenix J, Rider K, Sun AY. Premature ventricular contraction response-induced new-onset atrial fibrillation. HeartRhythm Case Rep. 2018;5(3):120-123. doi: 10.1016/j.hrcr.2018.11.012.
• 16. Ofoma U, He F, Shaffer ML, Naccarelli GV, Liao D. Premature cardiac contractions and risk of incident ischemic stroke. J Am Heart Assoc. 2012;1(5):e002519. doi: 10.1161/JAHA.112.002519.
• 17. Kim YG, Han KD, Choi JI, et al. Premature ventricular contraction is associated with increased risk of atrial fibrillation: a nationwide population-based study. Sci Rep. 2021;11(1):1601. doi: 10.1038/s41598-021-81229-0.