Daily Cardiology Research Analysis

BACKGROUND: The anatomical distribution of spontaneous ventricular ectopy and the risk of heart failure associated with premature ventricular contraction (PVC) location has not been studied outside the narrow group of individuals presenting for arrhythmia-related clinical care. OBJECTIVES: This study sought to describe the epidemiology of PVC site of origin and to determine whether PVC anatomical location is independently associated with incident heart failure risk. METHODS: Ambulatory adults without prevalent heart failure were identified from the CHS (Cardiovascular Health Study) and the ARIC (Atherosclerosis Risk in Communities Study) cohorts. Anatomical PVC location was assessed by 2 expert reviewers using baseline 12-lead electrocardiogram (ECG) morphology. RESULTS: Among 20,590 participants, 427 (2.1%) demonstrated at least 1 PVC on baseline ECG. Ventricular ectopy was localized to the left ventricle in 49% of participants, outflow tract in 27%, right ventricle in 22%, and epicardium in 2%. Over a mean follow-up of 19.2 years, ventricular ectopy on baseline ECG was associated with an increased adjusted risk of heart failure (HR: 1.43; 95% CI: 1.20 to 1.70; P < 0.001). Adjusted risk of incident heart failure was highest for PVCs arising from the epicardium (HR: 2.98; 95% CI: 1.12 to 7.95; P = 0.029) and the left ventricle (HR: 1.59; 95% CI: 1.30 to 1.94; P < 0.001). CONCLUSIONS: In a large population-based cohort, ventricular ectopy was most frequently localized to the left ventricle. Individuals with ectopy arising from the left ventricle and from epicardial locations experienced a higher likelihood of incident heart failure compared with those without PVCs or those with PVCs from other locations.

BACKGROUND AND AIMS: Absolute risk estimates of long-term cardiovascular complications after atrial fibrillation (AF) diagnosis from contemporary cohorts are needed to guide clinical care. Quantifying these risks can inform outcome selection in future randomised clinical trials and improve health service delivery. We systematically reviewed and synthesised incidence rates (IRs), risks and temporal trends of adverse cardiovascular events in patients with AF. METHODS: Longitudinal cohort studies published from 2015 onwards, reporting cardiovascular events in AF, were included. IRs were pooled using random-effects meta-analyses. Meta-regressions explored the influence of age, CHA RESULTS: 80 studies (5 498 857 patients) were identified, of which 73 studies, representing 24 817 465 person-years of follow-up, were included in the primary meta-analyses of IRs. Cardiovascular events in descending frequency were heart failure (IR 2.98 cases per 100 person-years, 95% CI 2.10 to 4.24), ischaemic stroke (IR 1.76 cases per 100 person-years, 95% CI 1.44 to 2.15), cardiovascular death (IR 1.66 cases per 100 person-years, 95% CI 1.24 to 2.23) and myocardial infarction (0.64 cases per 100 person-year, 95% CI 0.41 to 0.98). Except for heart failure (incidence rate ratio (IRR) 0.66, 95% CI 0.33 to 1.34), study outcomes declined over time (ischaemic stroke IRR 0.56, 95% CI 0.40 to 0.80; cardiovascular death IRR 0.52, 95% CI 0.29 to 0.93; myocardial infarction IRR 0.27, 95% CI 0.14 to 0.49). Sex differences appear to have diminished over time and were not found to be statistically significant in more recent studies. CONCLUSIONS: In patients with AF, heart failure was the most common and persistent adverse outcome. Despite improvement in stroke prevention, heart failure incidence has not declined, highlighting the need for targeted strategies and guideline focus. Further research is needed to address heart failure prevention and refine the understanding of sex-specific cardiovascular risks. PROSPERO REGISTRATION NUMBER: CRD42023474268.

BACKGROUND: Exercise electrocardiogram (ECG) remains widely performed in the assessment of patients with suspected cardiac chest pain. We aimed to assess the comparative diagnostic and prognostic yield of exercise ECG, single photon emission computed tomography (SPECT), and cardiovascular magnetic resonance (CMR), in a large prospective patient population. METHODS: Patients recruited to Clinical Evaluation of MAgnetic Resonance in Coronary heart disease (CE-MARC) who had exercise ECG were included and followed up to a median (interquartile range) of 6.3 (0.1, 6.8) years. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) for diagnostic accuracy were derived and hazard ratios of major adverse cardiovascular events (MACE) for prognostic significance were calculated. RESULTS: Of 752 patients in the CE-MARC trial, 580 had exercise ECG and invasive coronary angiography, of which 503 also had SPECT and CMR. At follow-up, a total of 91 (15.7%) patients experienced MACE. Using invasive angiography as the reference test, the sensitivity, specificity, PPV, and NPV (95% confidence interval) of exercise ECG were 68.3 (61.9, 74.0), 72.5 (67.6, 76.9), 61.0 (54.8, 66.8), 78.4 (73.7, 82.5). Exercise ECG was significantly less sensitive than CMR and less specific than both CMR and SPECT. A positive exercise ECG result was not predictive of MACE at follow-up (Hazard ratio 1.14 (0.75, 1.72), p = 0.53). CMR had both a greater diagnostic and prognostic yield than exercise ECG, SPECT, and their combination. Sequential CMR following inconclusive exercise ECG was comparable to CMR alone as the first-line test. CONCLUSION: In patients with suspected angina, CMR alone as the first-line test was more sensitive and prognostically accurate than exercise ECG, SPECT, or sequential combination of both tests.