Long-term outcome in asymptomatic men with exercise-induced premature ventricular depolarizations

Background: Exercise testing is widely used in the diagnosis of coronary ar tery disease, but the long-term outcome for asymptomatic persons with exerc ise-induced premature ventricular depolarizations remains unclear. We used data from the Paris Prospective Study I to assess the long-term outcome of such persons. Methods: A total of 6101 asymptomatic French men (42 to 53 years of age) wh o were free of clinically detectable cardiovascular disease underwent a sta ndardized graded exercise test between 1967 and 1972. Subjects were prospec tively classified as having or not having frequent premature ventricular de polarizations (a run of two or more consecutive premature ventricular depol arizations or premature ventricular depolarizations constituting more than 10 percent of all ventricular depolarizations during any of the 30-second e lectrocardiographic recordings). Results: During exercise, 138 subjects had frequent premature ventricular d epolarizations. After 23 years of follow-up, these subjects had a higher ri sk of death from cardiovascular causes than the men without frequent premat ure ventricular depolarizations during exercise (relative risk, 2.67; 95 pe rcent confidence interval, 1.76 to 4.07). In a multivariate model, with adj ustment for standard coronary risk factors and the presence or absence of p remature ventricular depolarizations before exercise and during recovery fr om exercise, both exercise-induced ischemia and the occurrence of frequent premature ventricular depolarizations during exercise remained independentl y associated with an increased risk of death from cardiovascular causes, wi th similar relative risks (2.63 [95 percent confidence interval, 1.93 to 3. 59] and 2.53 [95 percent confidence interval, 1.65 to 3.88], respectively). Conclusions: The occurrence of frequent premature ventricular depolarizatio ns during exercise in asymptomatic middle-aged men is associated with a lon g-term increase in the risk of death from cardiovascular causes. (N Engl J Med 2000;343:826-33.) (C) 2000, Massachusetts Medical Society.