Bedside identification of patients at risk for PVC-induced cardiomyopathy: Is ECG useful?

Noelle C. Garster, Charles Henrikson

    Research output: Contribution to journalArticle

    Abstract

    Background: Premature ventricular complexes (PVCs) are an underrecognized cause of cardiomyopathy. Standard 12-lead electrocardiogram (ECG) has potential to direct attention toward at-risk patients. Methods: We performed a single-center, retrospective chart review of 1,240 patients who completed ECG and Holter monitoring at Oregon Health and Science University Hospital between January 1, 2011 and December 31, 2013 to investigate the relationship of PVC frequency on ECG with burden on Holter. Primary outcome measures included PVC quantity on ECG, mean PVC quantity on Holter, and percentage of total beats on Holter recorded as PVCs. High PVC burden was defined as ≥10% of total beats. Results: Weighted mean percentages of total beats on Holter monitor recorded as PVCs were calculated for 0, 1, 2, and ≥3 PVCs on ECG and found to be 1.4% (n = 1,128), 3.5% (n = 32), 4.3% (n = 25), and 16.6% (n = 55), respectively, which represent statistically significant differences (P < 0.001). The positive predictive value of at least three PVCs on ECG for ≥10% PVC Holter burden was 58%. Negative predictive value for 0 PVCs on ECG was 98%. The sensitivity and specificity of ECG to identify high PVC burden on Holter was 72% and 93.6%, respectively, when utilizing a positive ECG result as one PVC or more, and 44% and 98.9%, respectively, with ≥3 PVCs on ECG. The positive likelihood ratio corresponding to ≥3 PVCs on ECG was 40. Conclusion: These findings demonstrate that the number of PVCs on ECG can be utilized for quick bedside estimation of high PVC burden.

    Original languageEnglish (US)
    Pages (from-to)794-797
    Number of pages4
    JournalPACE - Pacing and Clinical Electrophysiology
    Volume40
    Issue number7
    DOIs
    StatePublished - Jul 1 2017

    Fingerprint

    Ventricular Premature Complexes
    Cardiomyopathies
    Electrocardiography
    Ambulatory Electrocardiography

    Keywords

    • cardiomyopathy
    • electrocardiogram
    • Holter
    • premature ventricular complex

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

    Bedside identification of patients at risk for PVC-induced cardiomyopathy : Is ECG useful? / Garster, Noelle C.; Henrikson, Charles.

    In: PACE - Pacing and Clinical Electrophysiology, Vol. 40, No. 7, 01.07.2017, p. 794-797.

    Research output: Contribution to journalArticle

    @article{68f2d00bf070420c856b328e9e4b0603,
    title = "Bedside identification of patients at risk for PVC-induced cardiomyopathy: Is ECG useful?",
    abstract = "Background: Premature ventricular complexes (PVCs) are an underrecognized cause of cardiomyopathy. Standard 12-lead electrocardiogram (ECG) has potential to direct attention toward at-risk patients. Methods: We performed a single-center, retrospective chart review of 1,240 patients who completed ECG and Holter monitoring at Oregon Health and Science University Hospital between January 1, 2011 and December 31, 2013 to investigate the relationship of PVC frequency on ECG with burden on Holter. Primary outcome measures included PVC quantity on ECG, mean PVC quantity on Holter, and percentage of total beats on Holter recorded as PVCs. High PVC burden was defined as ≥10{\%} of total beats. Results: Weighted mean percentages of total beats on Holter monitor recorded as PVCs were calculated for 0, 1, 2, and ≥3 PVCs on ECG and found to be 1.4{\%} (n = 1,128), 3.5{\%} (n = 32), 4.3{\%} (n = 25), and 16.6{\%} (n = 55), respectively, which represent statistically significant differences (P < 0.001). The positive predictive value of at least three PVCs on ECG for ≥10{\%} PVC Holter burden was 58{\%}. Negative predictive value for 0 PVCs on ECG was 98{\%}. The sensitivity and specificity of ECG to identify high PVC burden on Holter was 72{\%} and 93.6{\%}, respectively, when utilizing a positive ECG result as one PVC or more, and 44{\%} and 98.9{\%}, respectively, with ≥3 PVCs on ECG. The positive likelihood ratio corresponding to ≥3 PVCs on ECG was 40. Conclusion: These findings demonstrate that the number of PVCs on ECG can be utilized for quick bedside estimation of high PVC burden.",
    keywords = "cardiomyopathy, electrocardiogram, Holter, premature ventricular complex",
    author = "Garster, {Noelle C.} and Charles Henrikson",
    year = "2017",
    month = "7",
    day = "1",
    doi = "10.1111/pace.13125",
    language = "English (US)",
    volume = "40",
    pages = "794--797",
    journal = "PACE - Pacing and Clinical Electrophysiology",
    issn = "0147-8389",
    publisher = "Wiley-Blackwell",
    number = "7",

    }

    TY - JOUR

    T1 - Bedside identification of patients at risk for PVC-induced cardiomyopathy

    T2 - Is ECG useful?

    AU - Garster, Noelle C.

    AU - Henrikson, Charles

    PY - 2017/7/1

    Y1 - 2017/7/1

    N2 - Background: Premature ventricular complexes (PVCs) are an underrecognized cause of cardiomyopathy. Standard 12-lead electrocardiogram (ECG) has potential to direct attention toward at-risk patients. Methods: We performed a single-center, retrospective chart review of 1,240 patients who completed ECG and Holter monitoring at Oregon Health and Science University Hospital between January 1, 2011 and December 31, 2013 to investigate the relationship of PVC frequency on ECG with burden on Holter. Primary outcome measures included PVC quantity on ECG, mean PVC quantity on Holter, and percentage of total beats on Holter recorded as PVCs. High PVC burden was defined as ≥10% of total beats. Results: Weighted mean percentages of total beats on Holter monitor recorded as PVCs were calculated for 0, 1, 2, and ≥3 PVCs on ECG and found to be 1.4% (n = 1,128), 3.5% (n = 32), 4.3% (n = 25), and 16.6% (n = 55), respectively, which represent statistically significant differences (P < 0.001). The positive predictive value of at least three PVCs on ECG for ≥10% PVC Holter burden was 58%. Negative predictive value for 0 PVCs on ECG was 98%. The sensitivity and specificity of ECG to identify high PVC burden on Holter was 72% and 93.6%, respectively, when utilizing a positive ECG result as one PVC or more, and 44% and 98.9%, respectively, with ≥3 PVCs on ECG. The positive likelihood ratio corresponding to ≥3 PVCs on ECG was 40. Conclusion: These findings demonstrate that the number of PVCs on ECG can be utilized for quick bedside estimation of high PVC burden.

    AB - Background: Premature ventricular complexes (PVCs) are an underrecognized cause of cardiomyopathy. Standard 12-lead electrocardiogram (ECG) has potential to direct attention toward at-risk patients. Methods: We performed a single-center, retrospective chart review of 1,240 patients who completed ECG and Holter monitoring at Oregon Health and Science University Hospital between January 1, 2011 and December 31, 2013 to investigate the relationship of PVC frequency on ECG with burden on Holter. Primary outcome measures included PVC quantity on ECG, mean PVC quantity on Holter, and percentage of total beats on Holter recorded as PVCs. High PVC burden was defined as ≥10% of total beats. Results: Weighted mean percentages of total beats on Holter monitor recorded as PVCs were calculated for 0, 1, 2, and ≥3 PVCs on ECG and found to be 1.4% (n = 1,128), 3.5% (n = 32), 4.3% (n = 25), and 16.6% (n = 55), respectively, which represent statistically significant differences (P < 0.001). The positive predictive value of at least three PVCs on ECG for ≥10% PVC Holter burden was 58%. Negative predictive value for 0 PVCs on ECG was 98%. The sensitivity and specificity of ECG to identify high PVC burden on Holter was 72% and 93.6%, respectively, when utilizing a positive ECG result as one PVC or more, and 44% and 98.9%, respectively, with ≥3 PVCs on ECG. The positive likelihood ratio corresponding to ≥3 PVCs on ECG was 40. Conclusion: These findings demonstrate that the number of PVCs on ECG can be utilized for quick bedside estimation of high PVC burden.

    KW - cardiomyopathy

    KW - electrocardiogram

    KW - Holter

    KW - premature ventricular complex

    UR - http://www.scopus.com/inward/record.url?scp=85021744719&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=85021744719&partnerID=8YFLogxK

    U2 - 10.1111/pace.13125

    DO - 10.1111/pace.13125

    M3 - Article

    C2 - 28567914

    AN - SCOPUS:85021744719

    VL - 40

    SP - 794

    EP - 797

    JO - PACE - Pacing and Clinical Electrophysiology

    JF - PACE - Pacing and Clinical Electrophysiology

    SN - 0147-8389

    IS - 7

    ER -