Background: A higher premature ventricular contraction (PVC) frequency predicts heart failure (HF) and death. While certain PVC characteristics may contribute to that risk, the current literature stems from patients in medical settings and is therefore prone to referral bias.
Objective: To identify PVC characteristics associated with incident HF in a community-based setting.
Methods: The Cardiovascular Health Study is a cohort of community-dwelling individuals that underwent comprehensive prospective evaluation and follow-up. We analyzed 24-hour Holter data obtained from a random sample of participants to assess PVC characteristics and used multivariable Cox proportional hazards models to identify predictors of incident HF.
Results: Of 778 analyzed participants, the average age was 72 ± 5 years, 42% were women, 93% were white, and 68% had at least one cardiovascular comorbidity. Over a median follow up of 11 years (IQR 6-16), 32% developed HF. After adjusting for demographics, HF risk factors, and PVC frequency, both longer PVC QRS duration and greater heterogeneity of the PVC coupling interval were associated with an increased risk of incident HF (Fig). Of note, coupling interval duration did not exhibit a statistically significant relationship with incident HF.
Conclusion: In this first community-based study to identify features of PVCs that predict incident HF, both greater PVC QRS duration and coupling interval heterogeneity were important, suggesting that ventricular dyssynchrony (wider PVC), variable ventricular filling and/or automaticity rather than triggered PVCs (variable coupling interval) may be important in PVC-induced cardiomyopathy.