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Old 01-06-2005, 09:55 PM   #1
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ventricular ectopy & exercise

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

 
Old 01-07-2005, 05:12 AM   #2
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Re: ventricular ectopy & exercise

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.

Quote:
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.

 
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Old 01-08-2005, 08:43 PM   #3
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Re: ventricular ectopy & 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.

 
Old 01-09-2005, 04:41 AM   #4
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Re: ventricular ectopy & exercise

Quote:
Originally Posted by Lenin
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.

Last edited by Machaon; 01-09-2005 at 04:44 AM.

 
Old 01-09-2005, 05:48 AM   #5
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Re: ventricular ectopy & exercise

Quote:
Originally Posted by beerzoids
Statistics can be fun to play with, but very misleading.
I wasn't "playing."

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


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.

Quote:
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.

Quote:
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.

Last edited by Lenin; 01-09-2005 at 05:55 AM.

 
Old 01-09-2005, 06:52 AM   #6
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Re: ventricular ectopy & exercise

Quote:
Originally Posted by Lenin
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....

 
Old 01-09-2005, 08:28 AM   #7
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Re: ventricular ectopy & exercise

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.

Last edited by KarenBeth; 01-09-2005 at 08:37 AM.

 
Old 01-09-2005, 12:19 PM   #8
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Re: ventricular ectopy & exercise

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

 
Old 01-09-2005, 12:43 PM   #9
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Re: ventricular ectopy & exercise

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.

 
Old 01-10-2005, 06:09 AM   #10
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Re: ventricular ectopy & exercise

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.

 
Old 01-10-2005, 09:32 AM   #11
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Re: ventricular ectopy & exercise

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

 
Old 01-11-2005, 04:48 AM   #12
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Re: ventricular ectopy & exercise

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.

 
Old 01-11-2005, 05:53 AM   #13
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Re: ventricular ectopy & exercise

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

 
Old 01-11-2005, 07:20 AM   #14
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Re: ventricular ectopy & exercise

Quote:
Originally Posted by KarenBeth
So how do you translate that in English, you know for those who didn't take CALC?
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.

 
Old 01-11-2005, 09:57 AM   #15
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Re: ventricular ectopy & exercise

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)

Last edited by KarenBeth; 01-11-2005 at 09:59 AM.

 
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