PVC-induced cardiomyopathy: the cut-off value for the premature ventricular contraction burden
Makaleler > Tam Makale · 2013
Yazarlar: Can HASDEMİR
Europace, Uluslararası, Wos, 2013, cilt 15, ss 1063-1063
Özet
I read with great interest the insightful study by Ban et al. entitled ‘Electrocardiographic and electrophysiological characteristics of premature ventricular complexes associated with left ventricular dysfunction in patients without structural heart disease’.1 Their study population consisted of 127 patients with symptomatic, frequent premature ventricular contractions (PVCs) who underwent catheter ablation. Twenty-eight (22%) patients had PVC-induced cardiomyopathy (PICMP). They concluded that PVC burden of >26% and the presence of retrograde P waves were independently associated with PICMP. The cut-off value for the PVC burden of >26% (with a sensitivity of 70% and specificity of 78%) was determined by receiver-operator characteristic (ROC) curve analysis. Premature ventricular contraction burden is certainly one of the strongest predictor of PICMP. Baman et al.2 and subsequently our group reported cut-off values for PVC burden in patients with PICMP as >24 and ≥16%, respectively, based on ROC curve analysis.3 The difference in cut-off values for PVC burden among different studies is probably due to several factors including selection biases and symptomatic status of the patients. A significant number of patients (almost 40%) with idiopathic PVCs seen in outpatient clinics are discovered coincidentally with a wide range of PVC burden. Ban et al.1 included mostly symptomatic patients with very frequent PVCs referred for catheter ablation. Therefore, their study population does not represent the patient population with idiopathic PVCs. I strongly believe that the performance of 24–48 h Holter monitoring and transthoracic echocardiography for the assessment of left ventricular ejection fraction (LVEF) by Simpson method in each consecutive, unselected patient with frequent, idiopathic PVCs in outpatient clinics is mandatory. So that we can detect each patient with depressed LVEF and potentially PICMP with lower cut-off value and wider range of PVC burden. Since our initial report, number of our patients with PICMP increased from 17 to 34.3 Recent ROC curve analysis (area under the curve = 0.939) in our study population for the cut-off value for the PVC burden showed that cut-off value of ≥16% is a valid number with sensitivity of 90% and specificity of 85%. Conflict of interest: none declared.