PREDICTIVE VALUE OF VENTRICULAR PREMATURE BEATS FOR SUBSEQUENT ISCHEMIC-HEART-DISEASE IN APPARENTLY HEALTHY-SUBJECTS

From 1978 to 1980, 260 healthy subjects, 40-79 years of age, underwent 24 h ambulatory electrocardiography in order to determine the prevalence and complexity of ventricular premature beats (VPBs) in adults without apparent heart disease. The number of types of VPBs seen in 5% or less were considered 'abnormal' and the present follow-up study undertaken in order to assess the significance of such 'abnormal' VPBs as predictors of subsequent ischaemic heart disease (IHD).Information concerning cardiac events within the follow-up period was available in 237 subjects. Nine were lost to follow up and 24 refused clinical examination. IHD was documented in 13 (eight myocardial infarction, five angina pectoris).'Abnormal' VPBs occurred in six out of 13 (46%) who later developed IHD compared to only 24 out of 213 (11%) without IHD (P<0·001). The presence of either more than 900 VPBs 24 h-1 or ventricular tachycardia of more than three beats, identified five out of 13 patients with IHD (sensitivity 38%), whereas 210 out of 213 with no evidence of IHD at follow-up were identified (specificity 98%). Four out of seven who initially had more than 900 VPBs 24 h-1 had IHD folllow-up.Our results have demonstrated a strong positive association between 'abnormal' VPBs observed in a random 24-h electrocardiographic recording of apparently healthy subjects 40-79 years of age and subsequent IHD. They also suggest that a 24-h ECG may be usefulfor the assessment of coronary risk even in asymptomatic subjects. © 1991 The European Society of Cardiology.