Association of Premature Ventricular Complex Burden with Echocardiographic and Hemodynamic Alterations in Patients with Structurally Normal Hearts

Abstract

Objective: Aim of this study was to evaluate the association between chronic premature ventricular complexes (PVCs) burden and echocardiographic as well as hemodynamic parameters in patients with structurally normal hearts. Methodology: This analytical cross-sectional study was conducted at the Department of Cardiology, DHQ Teaching Hospital KDA, Kohat. A total of 172 adult patients with documented PVCs on 24-hour Holter monitoring and structurally normal hearts were enrolled using non-probability consecutive sampling. PVC burden was categorized into three groups: 5 to <10%, 10 to <20%, and ≥20%. Comprehensive transthoracic echocardiography was performed to assess cardiac structure, systolic function, diastolic parameters, and hemodynamic indices. Results: The mean age of participants was 49.13 ± 8.38 years, and 55.2% were male. The mean PVC burden was 12.55 ± 5.70%. Patients with higher PVC burden demonstrated significantly larger left atrial diameter (p<0.001), higher mean 24-hour heart rate (p<0.001), increased left ventricular outflow tract velocity-time integral (LVOT VTI) (p<0.001), elevated tricuspid regurgitation gradient (p<0.001), and higher mitral E-wave velocity (p=0.006). Left ventricular ejection fraction remained preserved across all PVC burden categories (p=0.200). No significant differences were observed in left ventricular dimensions, left atrial volume index, cardiac output, or right ventricular systolic pressure. Conclusion: Increasing PVC burden in patients with structurally normal hearts is associated with subtle echocardiographic and hemodynamic alterations, particularly involving left atrial dimensions and Doppler-derived functional parameters, despite preserved left ventricular systolic function. These findings suggest that frequent PVCs may be associated with early subclinical cardiac remodeling and warrant careful clinical and echocardiographic surveillance.