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Five CK, Hasselberg NE, Chivulescu M, Rootwelt-Norberg C, Ribe MP, Dejgaard LA, Castrini AI, Aabel EW, Haugaa KH. Prediction of severe ventricular arrhythmias in patients with mitral valve prolapse by exercise ECG. Heart Rhythm 2024:S1547-5271(24)02503-7. [PMID: 38663787 DOI: 10.1016/j.hrthm.2024.04.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/15/2024]
Affiliation(s)
- Christian K Five
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nina E Hasselberg
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Monica Chivulescu
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
| | - Christine Rootwelt-Norberg
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Margareth P Ribe
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Lars A Dejgaard
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anna I Castrini
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eivind W Aabel
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristina H Haugaa
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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Five CK, Hasselberg NE, Aaserud LT, Castrini AI, Vlaisavljevic K, Lie Ø, Rootwelt-Norberg C, Aabel EW, Haugaa KH. Lifetime exercise dose and ventricular arrhythmias in patients with mitral valve prolapse. Europace 2023; 25:euad309. [PMID: 37851515 PMCID: PMC10616587 DOI: 10.1093/europace/euad309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
AIMS Patients with mitral valve prolapse (MVP) have high risk of life-threatening ventricular arrhythmias (VAs). Data on the impact of exercise on arrhythmic risk in these patients are lacking. We explored whether lifetime exercise dose was associated with severe VA and with established risk factors in patients with MVP. Furthermore, we explored the circumstances at the VA event. METHODS AND RESULTS In this retrospective cohort study, we included patients with MVP and assessed lifetime exercise dose as metabolic equivalents of task (MET) hours/week. Severe VA was defined as sustained ventricular tachycardia or fibrillation, aborted cardiac arrest, and appropriate shock by a primary preventive implantable cardioverter defibrillator. We included 136 MVP patients (48 years [interquartile range (IQR) 35-59], 61% female), and 17 (13%) had previous severe VA. The lifetime exercise dose did not differ in patients with and without severe VA (17 MET h/week [IQR 9-27] vs. 14 MET h/week [IQR 6-31], P = 0.34). Lifetime exercise dose > 9.6 MET h/week was a borderline significant marker for severe VA (OR 3.38, 95% CI 0.92-12.40, P = 0.07), while not when adjusted for age (OR 2.63, 95% CI 0.66-10.56, P = 0.17). Ventricular arrhythmia events occurred most frequently during wakeful rest (53%), followed by exercise (29%) and sleep (12%). CONCLUSION We found no clear association between moderate lifetime exercise dose and severe VA in patients with MVP. We cannot exclude an upper threshold for safe levels of exercise. Further studies are needed to explore exercise and risk of severe VA.
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Affiliation(s)
- Christian K Five
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Nina E Hasselberg
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Linda T Aaserud
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
| | - Anna Isotta Castrini
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Katarina Vlaisavljevic
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Øyvind Lie
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Christine Rootwelt-Norberg
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Eivind W Aabel
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Kristina H Haugaa
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
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Five CK, Hasselberg NE, Chivulescu M, Rootwelt-Norberg C, Ribe MP, Dejgaard L, Castrini AI, Aabel EW, Haugaa KH. Non-sustained ventricular arrhythmias at exercise ECG predict severe ventricular arrhythmias in arrhythmic mitral valve prolapse. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A subset of patients with mitral valve prolapse experience ventricular arrhythmias (VA) and even sudden cardiac death, defined as arrhythmic mitral valve prolapse (AMVP). Risk stratification of VA is challenging in this relatively young population. The predictive role of exercise testing has not been investigated.
Purpose
We aimed to explore if VA burden on exercise ECG can predict severe ventricular arrhythmic events in AMVP patients.
Methods
We included consecutive AMVP patients without prior severe VA referred to our tertiary center. Exercise bicycle ECG test by standard protocol was performed at inclusion. Non-sustained VT (nsVT) during exercise testing was defined as ≥3 consecutive ventricular beats with a rate ≥100/min lasting <30 seconds. Our endpoint of severe VA during follow-up was defined as aborted cardiac arrest, sustained ventricular tachycardia, nsVT with syncope or appropriate ICD shock therapy detected by either ECG, Holter monitoring, implantable loop recorder or primary preventive ICD.
Results
We included 91 AMVP patients without prior severe VA (51±16 years of age, 63% women) with exercise test at baseline. NsVT occurred in 5 patients during exercise testing. During 67±7 months of follow-up, 5 (5.5%) patients experienced severe VA. In all, 3 of the 5 (60%) with nsVT at exercise test experienced severe VA during follow-up, compared to only 2 of 86 (2%) without nsVT at exercise testing (age adjusted hazard ratio [HR] 35 [95% CI 5–249], p<0.001). Survival free from severe VA was worse in those with nsVT at exercise test (log rank p<0.001) (Figure 1).
Conclusions
Non-sustained VT occurring during exercise ECG testing was a strong marker of subsequent severe VA in AMVP patients without previous severe VA. These novel findings indicate that exercise testing may improve risk stratification in AMVP patients.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The Research Council of Norway.
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Affiliation(s)
- C K Five
- ProCardio Center for Innovation, Dept of Cardiology, Oslo University Hospital. University of Oslo , Oslo , Norway
| | - N E Hasselberg
- ProCardio Center for Innovation, Dept of Cardiology, Oslo University Hospital. University of Oslo , Oslo , Norway
| | - M Chivulescu
- ProCardio Center for Innovation, Dept of Cardiology, Oslo University Hospital. University of Oslo , Oslo , Norway
| | - C Rootwelt-Norberg
- ProCardio Center for Innovation, Dept of Cardiology, Oslo University Hospital. University of Oslo , Oslo , Norway
| | - M P Ribe
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet , Oslo , Norway
| | - L Dejgaard
- ProCardio Center for Innovation, Dept of Cardiology, Oslo University Hospital. University of Oslo , Oslo , Norway
| | - A I Castrini
- ProCardio Center for Innovation, Dept of Cardiology, Oslo University Hospital. University of Oslo , Oslo , Norway
| | - E W Aabel
- ProCardio Center for Innovation, Dept of Cardiology, Oslo University Hospital. University of Oslo , Oslo , Norway
| | - K H Haugaa
- ProCardio Center for Innovation, Dept of Cardiology, Oslo University Hospital. University of Oslo , Oslo , Norway
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