室性早搏负荷与无结构性心脏病患者长期心室重构的关联
该回顾性研究纳入5040例无结构性心脏病的室性早搏患者，按负荷分为<1%、1-10%和≥10%三组，评估长期心室结构或功能重构的复合终点。8年时复合终点发生率在三组分别为8.7%、14.5%和14.4%，负荷>1%与长期重构相关，1-10%负荷患者也可能需要随访监测。
要点
- 室性早搏负荷>1%与8年时心室结构或功能重构风险升高相关。
- 1-10%负荷组8年复合终点发生率为14.5%，接近≥10%组的14.4%。
- 单次24小时动态心电图可能低估未来风险，1-10%负荷者也应考虑随访。
核心结论
- 室性早搏负荷>1%与无结构性心脏病患者长期心室结构或功能重构相关。
研究设计与样本
- 回顾性研究，纳入2007年2月至2017年7月在韩国Asan Medical Center接受动态心电图和超声心动图检查的无结构性心脏病室性早搏患者5040例，按负荷分为<1%、1-10%和≥10%三组。
主要发现
- 8年时主要复合终点发生率在<1%、1-10%和≥10%组分别为8.7%、14.5%和14.4%（p<0.001）。
- 左心室收缩功能障碍发生率在三组分别为2.0%、4.9%和7.9%（p=0.009）。
- 左心室扩大发生率在三组分别为5.8%、8.5%和7.3%（p=0.007）。
- 更高室性早搏负荷与更年轻年龄、更少合并症和更低基线左心室射血分数相关。
临床怎么用
- 对无结构性心脏病但室性早搏负荷>1%的患者，应关注长期心室重构风险。
- 即使24小时动态心电图显示负荷为1-10%，也可能需要随访监测，因单次检查可能低估未来风险。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: The long-term association between premature ventricular complexes (PVCs) on ventricular structural and functional remodelling has not been well evaluated. The aim of this study was to assess the association between PVC burden and ventricular remodelling in individuals without structural heart disease. METHODS: This retrospective study analysed patients who underwent Holter monitoring and echocardiography between February 2007 and July 2017 at the Asan Medical Center, Korea. Patients were categorised based on PVC burden: <1%, 1-10% and ≥10%. The primary outcome was a composite of newly developed cardiac structural or functional remodelling, including left ventricular (LV) systolic dysfunction (<40%), severe LV enlargement and moderate-to-severe mitral and tricuspid regurgitations. Each component and all-cause mortality were also assessed. RESULTS: A total of 5040 patients with PVCs without structural heart disease were evaluated (mean age 58.8±13.1 years, 47.1% female). Higher PVC burden was associated with younger age, fewer comorbidities and lower baseline LV ejection fraction. The incidence of the primary outcome was significantly higher in the 1%-10% or PVC ≥10% groups compared with the <1% group (at 8 years, 8.7% vs 14.5% vs 14.4% for <1%, 1-10% and ≥10%, respectively; p<0.001). Higher PVC burden also correlated with increased rates of LV dysfunction (2.0%, 4.9%, 7.9%; p=0.009) and enlargement (5.8%, 8.5%, 7.3%; p=0.007). CONCLUSION: A PVC burden >1% was associated with long-term ventricular structural or functional remodelling. Given the dynamic nature of PVC burden, even patients with 1-10% burden may warrant follow-up monitoring, as a single 24-hour Holter may underestimate future risk.
引用
- Park J, Cho MS, Park S, et al. Premature ventricular contractions burden and long-term ventricular remodelling in patients without structural heart disease. Heart. 2026. PMID: 42209206. doi:10.1136/heartjnl-2025-327560
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。