Clinical relevance of exercise-induced ventricular arrhythmias in suspected coronary artery disease

Mark A. Marieb, George A. Beller, Robert S. Gibson, Bruce B. Lerman, Sanjiv Kaul

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    40 Scopus citations

    Abstract

    Because there is controversy regarding the clinical relevance of exercise-induced ventricular arrhythmias, we analyzed their significance in 383 patients who had undergone both exercise thallium-201 stress-testing and cardiac catheterization. Two-hundred twenty-one patients (58%) had no exercise-induced ventricular arrhythmias while 162 (42%) did. There was no difference between patients with and without exercise-induced ventricular arrhythmias in terms of previous myocardial infarction (p = 0.61), incidence of fixed thallium-201 defects (0.06), number of diseased vessels (p = 0.09) and resting left ventricular ejection fraction (p =0.06). In contrast, evidence of provocable ischemia (redistribution on thallium-201 and ST-segment depression on the electrocardiogram) were more likely (p < 0.02) to be seen in patients with exercise-induced ventricular arrhythmias. Discriminant function analysis revealed that these 2 variables best separated patients with and without exercise-induced ventricular arrhythmias. In a 4- to 8-year follow-up, 89 patients had adverse cardiac events. Of these 89, there were 41 deaths, 9 nonfatal myocardial infarctions and 39 coronary revascularization procedures performed later than 3 months after catheterization. Patients with exercise-induced ventricular arrhythmias were more likely (p = 0.01) to have these events than those without these arrhythmias. Moreover, these arrhythmias provided independent prognostic information beyond that provided by the thallium-201 stress test and coronary angiography. We conclude that exercise-induced ventricular arrhythmias are associated with exercise-induced ischemia and provide prognostic information which adds marginally to that provided by other noninvasive and invasive parameters in ambulatory patients being evaluated for chest pain.

    Original languageEnglish (US)
    Pages (from-to)172-178
    Number of pages7
    JournalThe American journal of cardiology
    Volume66
    Issue number2
    DOIs
    StatePublished - Jul 15 1990

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

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