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Prevalence and Association of Ventricular Tachycardia and Complex Ventricular Arrhythmias With New Coronary Events in Older Men and Women With and Without Cardiovascular Disease

^a Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla
^b Division of Clinical Epidemiology, University of Texas Medical School at Houston
^c Westchester Cardiology Associates, Scarsdale, New York
^d Department of Medicine, New York University School of Medicine, New York

Wilbert S. Aronow, Department of Medicine, New York Medical College, 23 Pebble Way, New Rochelle, NY 10804 E-mail: WSAronow{at}aol.com.

	Abstract

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Background. We report the prevalence of ventricular tachycardia (VT) and of complex ventricular arrhythmias (VA) and their association with new coronary events in older men and women.

Methods. The prevalence of VT and of complex VA detected by 24-hour ambulatory electrocardiograms and the incidence of new coronary events in older persons with coronary artery disease (CAD), with hypertension, valvular disease, or cardiomyopathy without CAD, and with no cardiovascular disease was investigated in 915 men (mean age 80 ± 8 years) and in 1,874 women (mean age 81 ± 8 years) in a long-term health care facility. Follow-up was 45 ± 30 months in men and 47 ± 30 months in women.

Results. The prevalence of VT was 16% in men and 15% in women with CAD, 9% in men and 8% in women with hypertension, valvular disease, or cardiomyopathy without CAD, and 3% in men and 2% in women with no cardiovascular disease. The prevalence of complex VA was 69% in men and 68% in women with CAD, 54% in men and 55% in women with hypertension, valvular disease, or cardiomyopathy without CAD, and 31% in men and 30% in women with no cardiovascular disease. In men and in women with CAD or with hypertension, valvular disease, or cardiomyopathy, VT and complex VA increased the incidence of new coronary events (p < .0001). Within each of the groups of patients, the incidences of new coronary events in men and in women with and without VT or complex VA were similar.

Conclusions. The prevalence of VT and of complex VA were similar in older men and women. VT and complex VA were associated with a higher incidence of new coronary events in men and women with CAD or with hypertension, valvular disease, or cardiomyopathy without CAD, but not in men and women with no cardiovascular disease.

NUMEROUS studies have demonstrated that persons with ventricular tachycardia (VT) or with complex ventricular arrhythmias (VA) detected by 24-hour ambulatory electrocardiograms (AECGs) associated with heart disease are at increased risk for developing new coronary events ^(1)(2)(3)(4). Older persons with VT or with complex VA detected by 24-hour AECGs ^(3)(4)(5) or induced by exercise ⁽⁶⁾⁽⁷⁾ and no clinical evidence of heart disease are not at increased risk for new coronary events. We report on data from a prospective study investigating the prevalence of VT and of complex VA detected by 24-hour AECGs and their association with new coronary events at 45-month follow-up in older men and at 47-month follow-up in older women with coronary artery disease (CAD), with hypertension, valvular heart disease, or cardiomyopathy without CAD, and with no clinical evidence of cardiovascular disease.

	Methods

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In a prospective study, technically adequate 24-hour AECGs for diagnosing VT and complex VA and technically adequate M-mode, 2-dimensional, continuous-wave Doppler, and pulsed Doppler echocardiograms for diagnosing valvular heart disease and cardiomyopathy were obtained in 915 unselected men, mean age 80 ± 8 years (range 60 to 100 years), and in 1,874 unselected women, mean age 81 ± 8 years (range 60 to 101 years), in a long-term health care facility. Valvular heart disease, hypertrophic cardiomyopathy, and idiopathic dilated cardiomyopathy were diagnosed as previously described ⁽⁸⁾. Hypertension was diagnosed according to the criteria of the Sixth Joint National Committee (JNC VI) Report on the Detection, Evaluation, and Treatment of Hypertension ⁽⁹⁾.

Technically satisfactory 24-hour AECGs were obtained using portable Avionics model 445 tape recorders (Irvine, CA) or SpaceLabs 2-channel recorders (model 90205; Redmond, WA) to obtain two leads corresponding to modified leads V₁ and V₅. Tapes were analyzed for arrhythmias by a CardioData MK 3 computer system (Haddonfield, NJ) or by a SpaceLabs FT 2000 computer system (Redmond, WA). All rhythm disturbances were written out on electrocardiographic paper at a paper speed of 25 mm/s and were verified by two cardiologists. VT was defined as three or more consecutive ventricular premature complexes ^(3)(4)(10). VT is considered sustained if it lasts 30 seconds or longer and nonsustained if it lasts <30 seconds. Complex VA included VT or paired, multiform, or frequent (30/hour) ventricular premature complexes ⁽³⁾⁽⁴⁾.

CAD was diagnosed if the person had a documented clinical history of myocardial infarction or electrocardiographic evidence of Q-wave myocardial infarction (n = 1,138) or typical angina pectoris without previous myocardial infarction (n = 28). Thirteen of the 28 persons (46%) with typical angina pectoris without myocardial infarction also had coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty.

New coronary events were diagnosed if the person developed nonfatal or fatal myocardial infarction ⁽¹¹⁾ or sudden cardiac death ⁽¹²⁾ as previously described. All coronary events were reviewed by the senior investigator with the physician taking care of the person.

Follow-up was from the time the 24-hour AECGs were obtained until the time of a new coronary event, death, or cutoff date for analysis of the data. Follow-up was 45 ± 30 months (range 1 to 184 months) in men and 47 ± 30 months (range 1 to 196 months) in women. For analyses comparing the two groups, chi-square tests and Fisher's exact tests were used for dichotomous variables (Table 1 Table 2 Table 3 Table 4 ).

	Results

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Table 3 shows the association of VT with the incidence of new coronary events at 45-month follow-up in men and at 47-month follow-up in women with CAD, with hypertension, valvular disease, or cardiomyopathy without CAD, and with no cardiovascular disease. Table 3 also lists levels of statistical significance. Table 4 shows the association of complex VA with the incidence of new coronary events at 45-month follow-up in men and at 47-month follow-up in women with CAD, with hypertension, valvular disease, or cardiomyopathy without CAD, and with no cardiovascular disease. Table 4 also lists levels of statistical significance.

	Discussion

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The prevalence of nonsustained VT detected by 24-hour AECGs was 4% in 98 older disease-free persons in the Baltimore Longitudinal Study of Aging ⁽¹⁰⁾, 4% in 106 active older persons ⁽¹³⁾, and 4% in 729 older women and 13% in 643 older men in the Cardiovascular Health Study ⁽¹⁴⁾. In the present prospective study, the prevalence of nonsustained VT detected by 24-hour AECGs was 16% in men and 15% in women with CAD, 9% in men and 8% in women with hypertension, valvular heart disease, or cardiomyopathy without CAD, and 3% in men and 2% in women with no clinical evidence of cardiovascular disease.

The prevalence of complex VA detected by 24-hour AECGs in older persons was 50% in 98 older disease-free persons in the Baltimore Longitudinal Study of Aging ⁽¹⁰⁾, 31% in 106 active older persons ⁽¹³⁾, and 16% in 729 older women and 28% in 643 older men in the Cardiovascular Health Study ⁽¹⁴⁾. In the present prospective study, the prevalence of complex VA detected by 24-hour AECGs was 69% in men and 68% in women with CAD, 54% in men and 55% in women with hypertension, valvular heart disease, or cardiomyopathy without CAD, and 31% in men and 30% in women with no clinical evidence of cardiovascular disease.

Numerous studies have documented that VT and complex VA are associated with an increased incidence of new coronary events in persons with heart disease ^(1)(2)(3)(4). In the present study, VT significantly increased the incidence of new coronary events by 1.7 times in men and by 1.7 times in women with CAD and by 1.9 times in men and by 2.0 times in women with hypertension, valvular heart disease, or cardiomyopathy without CAD. In the present study, complex VA significantly increased the incidence of new coronary events by 2.4 times in men and by 2.5 times in women with CAD and by 1.9 times in men and by 2.2 times in women with hypertension, valvular heart disease, or cardiomyopathy without CAD.

Older persons with VT or with complex VA detected by 24-hour AECGs or by exercise and no clinical evidence of heart disease are not at increased risk for new coronary events ^{(3)(4)(5)(6)(7)}. In the present prospective study of 135 older men and 297 older women with no clinical evidence of cardiovascular disease, nonsustained VT and complex VA were not associated with an increased incidence of new coronary events.

Received June 19, 2001

Accepted July 25, 2001

	References

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