Evidence map›Paper›PMID 34857087›Full record

ArticleJournal of the American College of Cardiology2021

Exercise-Induced Ventricular Ectopy and Cardiovascular Mortality in Asymptomatic Individuals.

Marwan M Refaat, Charbel Gharios, M Vinayaga Moorthy, Farah Abdulhai, Roger S Blumenthal, Miran A Jaffa, Samia Mora

Open access · greenAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American College of Cardiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 4 pooled it
4.4field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 4 syntheses or guidelines pooled it, 40 citations in OpenAlex.

  1. Pooled it
  2. Guideline
  3. Pooled it
  4. Pooled it
  5. Premature ventricular complexes.Clinical medicine (London, England) · 2026
    Review
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  8. Observational
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  19. Survived sudden cardiac death in a patient with arrhythmic mitral valve prolapse syndrome: a case report.Clinical research in cardiology : official journal of the German Cardiac Society · 2023
    Article
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 2 countries.

Marwan M RefaatDepartment of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon; Department of Biochemistry and Molecular Genetics, American University of Beirut Faculty of Medicine, Beirut, Lebanon.
Charbel GhariosDepartment of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon; Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
M Vinayaga MoorthyCenter for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Farah AbdulhaiDepartment of Internal Medicine, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon.
Roger S BlumenthalThe Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland, USA.
Miran A JaffaEpidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. Electronic address: ms148@aub.edu.lb.
Samia MoraCenter for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Electronic address: smora@bwh.harvard.edu.
American University of Beirut Medical Center · LBBrigham and Women's Hospital · USAmerican University of Beirut · LBHarvard University · US

Funding

Genetic and Metabolic Determinants of 25(OH)D levels at Baseline and One Year: Findings from a Dose Ranging Vitamin D trialD43TW009118 · FIC · AMERICAN UNIVERSITY OF BEIRUT · PI FULEIHAN, GHADA ELHAJJ · 2012 to 2024
$2.5M
Patient Centered Approaches to Preventing ASCVD EventsK24HL136852 · NHLBI · BRIGHAM AND WOMEN'S HOSPITAL · PI SAMIA MORA · 2018 to 2026
$1.1M
FIC NIH HHS D43 TW009118NHLBI NIH HHS K24 HL136852
6 · The paper itself

Abstract

backgroundThe prognosis of exercise-induced premature ventricular contractions (PVCs) in asymptomatic individuals is unclear.

objectivesThis study sought to investigate whether high-grade PVCs during stress testing predict mortality in asymptomatic individuals.

methodsA cohort of 5,486 asymptomatic individuals who took part in the Lipid Research Clinics prospective cohort had baseline interview, physical examination, blood tests, and underwent Bruce protocol treadmill testing. Adjusted Cox survival models evaluated the association of exercise-induced high-grade PVCs (defined as either frequent (>10 per minute), multifocal, R-on-T type, or ≥2 PVCs in a row) with all-cause and cardiovascular mortality.

resultsMean baseline age was 45.4 ± 10.8 years; 42% were women. During a mean follow-up of 20.2 ± 3.9 years, 840 deaths occurred, including 311 cardiovascular deaths. High-grade PVCs occurred during exercise in 1.8% of individuals, during recovery in 2.4%, and during both in 0.8%. After adjusting for age, sex, diabetes, hypertension, lipids, smoking, body mass index, and family history of premature coronary disease, high-grade PVCs during recovery were associated with cardiovascular mortality (hazard ratio [HR]: 1.82; 95% CI: 1.19-2.79; P = 0.006), which remained significant after further adjusting for exercise duration, heart rate recovery, achieving target heart rate, and ST-segment depression (HR: 1.68; 95% CI: 1.09-2.60; P = 0.020). Results were similar by clinical subgroups. High-grade PVCs occurring during the exercise phase were not associated with increased risk. Recovery PVCs did not improve 20-year cardiovascular mortality risk discrimination beyond clinical variables.

conclusionsHigh-grade PVCs occurring during recovery were associated with long-term risk of cardiovascular mortality in asymptomatic individuals, whereas PVCs occurring only during exercise were not associated with increased risk.

Indexed as

ExerciseExercise TestFemaleFollow-Up StudiesHeart RateHumansMaleMiddle AgedNorth AmericaPrognosisProspective StudiesRisk AssessmentSurvival RateVentricular Premature Complexescardiac arrhythmiacardiovascular diseaseheart diseasepremature ventricular contractionstress testventricular ectopy

Identifiers

PMID34857087
PMCPMC8720278
OpenAlexW3216614471

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.