I recently found out through a treadmill test that I have frequent (>6/minute) asymptomatic ventricular ectopy. PVC's. Premature ventricular contractions. Pretty harmless, I believe, but could this be the reason I have always felt I get winded easily while running, and can't seem to build up much endurance? Thanks!

Sue

Sue,
It's not all that harmless.
There's a big study (30,000 people) that shows a somehat increased risk of death if the ectopic (premature) beats occur on exercise but a 240% increased risk if the ectopic beats start during RECOVERY from exercise.

Frequent ventricular ectopy during exercise predicted an increased risk of death (five-year death rate, 9 percent, vs. 5 percent among patients without frequent ventricular ectopy during exercise; hazard ratio, 1.8; 95 percent confidence interval, 1.5 to 2.1; P<0.001), but frequent ventricular ectopy during recovery was a stronger predictor (11 percent vs. 5 percent; hazard ratio, 2.4; 95 percent confidence interval, 2.0 to 2.9; P<0.001). After propensity matching for confounding variables, frequent ventricular ectopy during recovery predicted an increased risk of death (adjusted hazard ratio, 1.5; 95 percent confidence interval, 1.1 to 1.9; P=0.003), but frequent ventricular ectopy during exercise did not (adjusted hazard ratio, 1.1; 95 percent confidence interval, 0.9 to 1.3; P=0.53).

Conclusions Frequent ventricular ectopy during recovery after exercise is a better predictor of an increased risk of death than ventricular ectopy occurring only during exercise.

Well what did the Doctor say when he saw those PVC's on the treadmill test? was he concerned? If it was a REAL huge concern, he would have told you.

Sue,
It's not all that harmless.
There's a big study (30,000 people) that shows a somehat increased risk of death if the ectopic (premature) beats occur on exercise but a 240% increased risk if the ectopic beats start during RECOVERY from exercise.

Statistics can be fun to play with, but very misleading.

What does your "240% increased risk" mean? How does it relate to Sue's question?

Also, what is the "hazard" ratio mean? Do you know the meaning of the 95 "percent confidence interval, 2.0 to 2.9; P<0.001", that you posted?

I appreciate your input on this question. It's nice to have someone who can interpret confusing test results.

Statistics can be fun to play with, but very misleading.
I wasn't "playing."

What does your "240% increased risk" mean?
That seems self-evident to me...the correct quote was "risk OF DEATH." [/QUOTE]


How does it relate to Sue's question?
Sue, made the comment: "Pretty harmless, I believe." I was indicating to her that perhaps it's not quite so harmless. Whether it is causing her breath shorntess or not, I'm not sure, but the shortness of breath certainly isn't a MITIGATING factor.

Do you know the meaning of the 95 "percent confidence interval, 2.0 to 2.9; P<0.001", that you posted?
Yes, I do.

I appreciate your input on this question. It's nice to have someone who can interpret confusing test results.
Thank you!

What I sould hope that Sue got from the study is the need to ascertain WHEN the ectopic beats began and if they began at rest AFTER exercise to perhaps take further action.

I wasn't "playing."


That seems self-evident to me...the correct quote was "risk OF DEATH."


Forgive me for not understanding. You said that ectopic (premature) beats occurring during RECOVERY from exercise showed a 240% increased risk of death.

240% more risk of dying than who? How did you come up with the 240%?

Any type of heart rhythm problem should be fully checked out, and appropriate corrective action should be taken, but a 240% increased risk of death sounds very serious. How serious is it in this case?

Thanks....

I was going to ask the same question.. my cardiologist said that wasn't true, if you have a healthy heart with PVC's there is no risk of sudden death, whether you get them with excercise or get them whem coming down from exercise.

240% is a huge number and there is nothing in compare to it.. I never heard of this at all.

Lets just put it this way, if Sue was having these during or right after a stress test with the cardiologist right there with her and saw this, and it was serious? he wouldn't have sent her home and would have checked her into the closest hospital.. if she has a healthy heart, and all her tests came back normal, and she has PVC's with or after working out, then it seems to be "harmless" in her situation. I am SURE the Dr would have told her if there was any concern at all.

To throw all these stats in your reply is giving those the wrong idea about the difference between PVC's in a healthy heart or a Diseased heart. There are a million different "opinions" of PVC's on the internet, but the only person you should be concerned about is what the Cardiologist says when YOU see him Sue.. if he says it harmless, then you go by what he says, not some stats and numbers.

My test was done 1 1/2 years ago and at the time, all they told me was that it was fine. I just recently requested a copy of the report and that's when I discovered the particulars. Apparently they didn't think it was a problem and so said nothing to me about it. Or possibly they felt--why worry the patient about an increase in the risk of death (9% over 10 years rather than 5%), when there's nothing that can be done about it? The report stated "It may be advisable to modify known cardiac risk factors (ASA, lipids, BP) to further reduce risk, though this has not yet been proven." They already knew my other risk factors were low--I am normal weight, I exercise, eat low-fat, don't have high blood pressure, cholesterol is low, etc. But what are ASA's? I am thinking of calling them about that.

It was stated that the ventricular ectoby was during exercise. Though elsewhere in the report was this--"Arrythmia: some PVC's >6/min in stage 2 and in recovery had frequent PACs and possible transient 2nd Degree AVB, was in NSR upon termination of recovery period."

Do you know what PACs are, or 2nd degree AVB, or NSR? I may also call them about that. Thanks!

Sue

PAC's are Premature Atrial Contractions, from the upper chambers vs the PVC's that are lower Chambers.

I know a person who has dealt with PVC's and PAC's during excercise for over 20 years and he is still fine.. Stats are stats, but everyone is different from another person, no matter how many studies are taken.

If you are healthy, and you take good care of yourself, avoid the risk factors, and do what your cardiologist tells you what to do, then you will be fine. My cardiologist said that PVC's and PAC's in a normal healthy heart are HARMLESS with no STATS! Like I said, if there was a problem when you were doing the stress test, they would have really been concerned and told you about that.. a DR cannot withhold important information from you ESPECIALLY if it's a risk factor. I am sure he saw nothing wrong, and if you have any other concerns, I would talk to him again if it makes you feel any better.

This is why stats are never good to go by.. don't listen to what anyone says besides your cardiologist. If you are really concerned about it, talk to your cardiologist about it, he will know more than any stat sheet on the internet.

Don't worry about it, if your DR said that your heart is healthy, and your PVC's are benign, then you go by what he says. But if you are REALLY worried about what was said on here, it wouldn't hurt to make an appointment with him and talk to him/her about it.

To be honest, I think these stats that this person posted were going by a heart that had problems vs a healthy heart.. don't believe what you read.. trust me, there is alot of hear say info on the internet of people thinking they know what it's all about when they don't.

My test was done by a technician and later read by a cardiologist.

After receiving the report I did some internet research and I did see the same statistics about a 240% increase in sudden death if the PVCs occured during recovery. A much smaller increase was shown for PVCs during exercise. I'm not relly too concerned about mine but was just curious if it might be affecting my exercise tolerance.

Sue

Actually, what I see in the quote is the following, just treating the raw data in the study for the PVCs resulted in:
1) 1.8 (180%) risk probability increase for those that experience frequent PVCs during exercise, compared to those that do not. This level is statistically significant at the 95% confidence level and the P < 0.001 indicates that one can state so with (99.9%+ probability).
2)2.4 (240%) risk increase for those that had PVCs during the recovery, compared to those that did not. Again, the stats are reasonably strong here.

However, based just on those two findings, how much difference is there really between 1.8 and 2.4? Both seem to indicate increased risk, and strongly so.

Where it gets interesting is when propensity matching is done for confounding variables (what those are, we have no clue--would need to read the paper for that).

3) The recovery risk is now adjusted to 1.5 (150% probability) over those that do not experience PVCs, but look at the range (1.1 to 1.9); although, the P=0.003. So this is 99.7% certain.

4) The PVC during exercise group had a mean risk of 1.1 compared to the non-PVC group. Since 1.0 would be equivalent, we expect these means to be almost on top of each other (range 0.9 to 1.3 for the 95% confidence level) and the P=0.53. That indicates that there is not a statistically significant difference in the means of these groups.

Now, what has not been established is how the means of the test variables in 3 and 4 compare.... In other words, is the 1.5 hazard risk (range 1.1 to 1.9) statistically significant from the 1.1 hazard (0.9 to 1.3). There is some overlap of the two curves for the 95% level confidence limites. This would seem to indicate that the P would be >0.05 and that these risks are not different statistically, at least not at that level. In other words, it would indicate that you still might not be able to see the PVCs after exercise are any better predictor than PVCs during exercise, if you only compare these two groups. Granted I haven't worked through the calcs on the limits to establish this, so feel free to correct me on that if I am wrong.

So how do you translate that in English, you know for those who didn't take CALC? :rolleyes:

So how do you translate that in English, you know for those who didn't take CALC? :rolleyes:

That if you ignore some variables in the experiment, you can state with reasonable confidence that in a 5-year time frame, there is a 240% higher incidence of death in individuals with PVCs after exercise compared to those that don't have PVCs during/after exercise. There is a 180% higher probability of death in those that have PVCs during exercise compared to those that do not have PVCs during/after.

If you then consider some other variables (I don't know what they are without reading the manuscript), then only the data for the individuals with PVCs after exercise is different than the control group which do not experience PVCs. In that case, the 5-year death rate risk is 1.5 times that of the control population. For those that experience PVCs during exercise, their death rate in 5 years was no different (statistically) than the death rate in individuals that don't experience PVCs.

What you find, sometimes, in data is that even when you can show that your treatment group (mean) are statistically different than the control (mean(s)), multiple treatment (means) may not be statistically different from each other. That is what we don't know in this case.

OKAY... well I don't know anymore really than I did before except to say that Stats are Stats and people are people... I would love to know where they base their stats on? I think these stats just gives a reason to scare the crap out of anyone who has PVC's during or NOT during a working out, and to make them not workout anymore at all.. I am sure this topic is going to send alot of people out and running the treadmill today (sarcastically speaking that is)

I'm confused now.
You say there is a 180% higher probability of death in those that have PVCs during exercise compared to those that do not have PVCs during/after.

But I read on a website--"Ventricular ectopy during exercise was associated with a 9 percent mortality rate, compared to a 5 percent mortality rate in those without ectopy." (Over a 10 year period).

Sue

Here is something I found that was NOT mentioned in all the above Stats.. these percentages are based on other health risk factors in patients.. like old age, diseases, smokers and so on.. read below

-------------------

Survival is decreased when frequent ventricular ectopy follows exercise testing (NEJM 2003: 348:781)

Froklis et al at the Cleveland Clinic found that frequent ventricular ectopy after exercise tests have an increased death rate (9 vs 5 percent death rate at 5 year follow up). This was derived from a study of over 29,000 patients referred for a symptom limited stress test who did not have a history of heart failure, valve disease or arrhythmia.

Definition: Frequent ventricular ectopy was defined as > 7 PVC/minute, bi or trigeminy, couplets, triplets, ventricular tachycardia, flutter, torsade, or fibrillation. Patients with the most severe ventricular ectopy (triplets or worse) had the greatest 5 year mortality (11%).

Patients with frequent ventricular ectopy during exercise only had slightly worsened survival, but this was not independent of other risk factors such as old age, male sex, diabetes,smoking, reduced exercise tolerance, and abnormal heart rate recovery. Alternatively, frequent recovery ectopy was an independent predictor of increased death rate. The mechanism may, like abnormal heart rate recovery, relate to reduced return of vagal tone post exercise.

I'm confused now.
You say there is a 180% higher probability of death in those that have PVCs during exercise compared to those that do not have PVCs during/after.

But I read on a website--"Ventricular ectopy during exercise was associated with a 9 percent mortality rate, compared to a 5 percent mortality rate in those without ectopy." (Over a 10 year period).

Sue

You got it :) 9%:5% is 9/5 = 1.8. The risk ratio is 1.8, and that corresponds to 180%. Just like the other figure was something like 11% to 5%. So 11/5 = 2.2, which means 220% increased likelihood. Does that make any more sense than what I wrote before?

I thought I read over a 5-year period, but I may have misread that?

just more worried than before so does that mean all factors such as people with heart problems weren't taken in to account when they previously posted and that these stats are for ventricular ectopic beats in general whether the hearty is healthy or not?

The patient pool should also considered when evaluating the results:

From the study: ===> "We studied 29,244 patients (mean [±SD] age, 56±11 years; 70 percent men) who had been referred for symptom-limited exercise testing without a history of heart failure, valve disease, or arrhythmia." <===

.

Also to be considered: ===> "After propensity matching for confounding variables, frequent ventricular ectopy during recovery predicted an increased risk of death (adjusted hazard ratio, 1.5; 95 percent confidence interval, 1.1 to 1.9; P=0.003), but frequent ventricular ectopy during exercise did not (adjusted hazard ratio, 1.1; 95 percent confidence interval, 0.9 to 1.3; P=0.53)." <===

.

9% of those with frequent PVCs during recovery from exercise, with a mean age of 56, died within five years. That means that 91% didn't die within 5 years. So while the risk of dying is 150% higher of dying within 5 years, the risk of living at least another 5 years is about 1500% higher, if you are in this group of people with a median age of 56.

The results of the study are significant, but not earth shaking.

Statistics can be fun to play with.

Yeah stats can be fun to play with, and can also be misleading. I don't think it's appropiate to sit and the throw stats on a board that is suppose to HELP people with their heart problems and concerns, not scare the crap out of them with a bunch of numbers.

Yeah stats can be fun to play with, and can also be misleading. I don't think it's appropiate to sit and the throw stats on a board that is suppose to HELP people with their heart problems and concerns, not scare the crap out of them with a bunch of numbers.

I agree with you.

sjde certainly got more than she bargained for, but less than she wanted.

sjde was interested in if her PVCs were related to why she got winded easily while running.

To me, once a heart gets sensitive, and starts to misfire, then there are a lot of things that can cause PVCs, or PACs, or tachycardias, or a slow heart beat, or a weak heart beat, or too strong of a heart beat.

When the heart is not firing correctly, regardless of the exact mechanism, it is not going to support physical activity like running. The heart won't be able to keep up with the body.

When my heart misfires a little, I am still able to do normal activities, but when my heart gets additionally irritated, it misfires worse, and I am more limited. When I notice that my heart is getting additionally irritated, I really take it easy, and try to not come into contact with something that will make it misfire even worse.

I just thought the article and stats about PVC's with or recover after working out was necessary, it's bad enough that people on here are in fear of their PVC's or heart arrhythmia's, but to throw death rates and increased risk of death stats at someone, it's just not right. Leave the stats up to those who go out looking for them, I believe that support on this board is what others need, not medical stats.

I just thought the article and stats about PVC's with or recover after working out was necessary, it's bad enough that people on here are in fear of their PVC's or heart arrhythmia's, but to throw death rates and increased risk of death stats at someone, it's just not right. Leave the stats up to those who go out looking for them, I believe that support on this board is what others need, not medical stats.

KarenBeth,

I did not originally point out the article, but I was trying to point out that the the linkage between PVCs before/after/during was not as strong as it may have seemed first. (Beerzoids explained that and brought up some other points of that study--I didn't look up the paper).

Maybe I didn't do as well of a job pointing out what I wanted to say, originally. I will have to write the dissenting opinion to yours on this. ;) All of us come here for one reason or another, and in my case, it is to better understand my own plight of heart disease at a young age. I feel there is nothing wrong with trying to explain statistics here, because how else can we attempt to learn and educate ourselves? I believe this board is here for support for some, for clarification of questions for others, and for insightful (and critical) discussion of recent scientific work for others--perhaps me in this case, since research and publication of scientific results is what I do for a living. I don't think that any of us were trying to scare anyone, or run anyone off. I apologize if I did so in any of my posts.

As you probably know, a good proportion of medical recommendations are based on studies which, almost without exception, require statistical analysis for publication (and acceptance) of the research results. I am not sure we can get away from the stats, but if some of us try to understand that significance, or insignficance of them, we might be able to put our minds at ease? I think we differ on how we look at that.... :)

man im not buying this study at all...unless someone can link me to the complete study and not just post simple quotes....i cant even begin to draw conclusions from it

im throughly convinced that my PVC's started due to my lack of exercise and lacadsical lifestyle, and infrequent marijuna use. since ive started a pretty solid exercise regime the PVC's have subsdided, and become less frequent. And even when i get them they are more just little tremors then full flat out heart jumps. And ive had plenty of PVC's while coolign down after a workout, i almost just expect it by now, as part of my cool down. i stand longer and walk around longer as oppossed to jsut sitting down and catching my breath. Becasue i find that i get them more when sitting down during the end of a cool down phase....so i just keep moving and walking around my house after my workout. example being that that walkin up steps a yr ago would have made my heart beat hard thourgh my chest, witha few possible flutters. yesterday i ran 2.5 miles and walked back to the house with not a care in the world, and my heart cooling down just fine....

For me, exercise and getting back in shape is nothign but a healthy solution to my PVC's, however i will add that when i go through a period of PVC's usually for me 2-4 days, i stop workign out, and slow down, eat a lot of green vegetables, take some vitamin supplements and dont stress the heart out at all

im not reccomending it for everyone, like its been said you need to follow up with your cardio and thier assement of your flutters.....everyone is different

But i find this study to be very questonable and lacking in solid scientific method