Risk factors for the development of premature ventricular complex-induced cardiomyopathy: a systematic review and meta-analysis

Premature ventricular complexes (PVCs) can be a reversible cause of heart failure. To date, it is unclear which risk factors contribute to the development of impaired left ventricular function.

Systematically assessing risk factors for the development of PVC-induced cardiomyopathy (PVC-CM).

We performed a structured database search of the scientific literature for studies investigating risk factors for the development of PVC-induced Cardiomyopathy. We investigated the reporting of PVC-induced Cardiomyopathy risk factors (RF) and assessed the comparative association of the different RF using random-effect meta-analysis.

A total of 26 studies (9 prospective and 17 retrospective studies) involving 16.764.641 patients were analyzed (mean age 55 y, 58% women, mean PVC burden 17%). Suitable for quantitative analysis were 25 studies examining 6738 (0.04%) patients and 11 RF (≥3 occurrences in multivariable model assessing a binary change in left ventricular - LV- function). Among these risk factors, age (OR 1.02 per increase in the year of age, 95%-CI [1.01, 1.02]), the presence of symptoms (OR 0.18, 95%-CI [0.05, 0.64]), non-sustained VTs (OR 3.01, 95%-CI [1.39, 6.50]), LV origin (OR 2.20, 95%-CI [1.14, 4.23]), epicardial origin (OR 4.72, 95%-CI [1.81, 12.34]), the presence of interpolation - PVCs that do not reset the RR interval (OR 4.93, 95%-CI [1.66, 14.69]) and overall PVC burden (OR 1.06, 95%-CI [1.04, 1.08]) were all significantly associated with PVC-induced Cardiomyopathy. (Figures 1,2)

In this meta-analysis, the most consistent risk factors for PVC-CM were age, non-sustained VTs, LV and epicardial origin, interpolation, and PVC burden, while the presence of symptoms significantly reduced the risk. These findings help tailor stringent follow-up to patients presenting with frequent PVCs and normal LV function.

Type of funding sources: None.