A retrospective cohort study concluded that high-grade exercise-induced premature ventricular contractions (PVCs) occurring during recovery were associated with long-term risk of cardiovascular mortality in asymptomatic individuals, but not PVCs occurring only during exercise. The study included a total of 5,486 asymptomatic individuals with a mean age of 45.4 years and 42% women. There were 840 deaths during a mean follow-up of 20.2 years, including 311 cardiovascular deaths. High-grade PVCs (defined as either frequent [>10 per minute], multifocal, R-on-T type, or ≥2 PVCs in a row) 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), which remained significant after further adjusting for exercise duration, heart rate recovery, achieving target heart rate, and ST-segment depression (HR: 1.68). Results were similar by clinical subgroups. However, 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 risk factors; neither during exercise nor recovery PVCs were associated with all-cause mortality. The findings are in line with previous studies and suggest that exercise-induced PVCs during recovery, reflective of a reduction in vagal reactivation after exercise, may be of greater prognostic value. Source: https://www.jacc.org/
