Evaluation Of Spontaneous Variability And Quality Of Life And Analyse The Relationship Between The Burden And The Origin Sites Of PVCs About The Cardiac Structural And Functional Remodeling In The Frequency Of PVCs Patients Using 7-day Holter Monitor

Part Ⅰ:Evaluation of Spontaneous Variability in the Frequency of PVCs using 7-day Holter MonitorBackground:Incidence of Premature ventricular contractions is related to the detection methods and study population, the detection rate in the normal population with 12-lead ECG is 1%, the 24-48 hour ambulatory monitoringthe detection rate is (40-75)%, which means there is still half of the patients was missed diagnosed after the 24-hour Holter detection.Objectives:The aim of this study was to evaluate spontaneous variability in the PVCs patients for seven days consecutive electrocardiograph monitoring, to provide a scientific basis to improve the detection rate of PVCs patients, analysis the influencing factors of spontaneous variability of PVCs patients, to provide a more comprehensive basis of the treatment for PVCs patients.Methods:From May 2012 to April 2013,101 cases PVCs patients come from cardiovascular clinic and ward of the Jiangsu Province People’s Hospital. Collectting the basic information of the patients, all patients underwent physical examination to exclude related diseases,12-lead ECG, 7 days Holter monitoring, if necessary, some patients underwent cardiac electrophysiology examination or coronary angiography.Results:Seven days spontaneous variability is between (5-100)%, the average degree of variation is (45.17±25.58)%, the variability is greater than 50% in the RVOT origin group, the tricuspid valve origin group has the smallest variability, minimum load of 7 days is 0.01, the maximum value is 49.51(14.76±12.14)%, regression analysis showed that the heart rate, the patient burdern and the site of origin of ventricular premature variability were influencing factors, heart rate correlated with premature ventricular contractions variability negatively (r=-0.349, P<0.01); PVCs burdern correlated with PVCs variability negatively (r=-0.556, P<0.01).Conclusion:Premature ventricular contractions origin from RVOT were more common, the natural variability in patients origin from all parts is more than 20%, the burden variability is greater than 25%,7-day Holter recorder increase the detection rate of the PVCs. Patients have complained of symptoms but absence abnormal in once Holter monitoring should be strengthen the follow-up monitoring.Part II:The relationship between the burden and the sites of origin of frequent premature ventricular contractions and the cardiac structural and functional remodelingBackground:Studies found that the frequency of ventricular premature is related with the structure and function of left ventricular. The PVCs burdern in patients with reduced LVEF (29-37)%is higher than patients with normal left ventricular function (8-13)%. So far, there is rare reports about the relationship with PVCs burdern and cardiac structure and function, whether there are differences between originating of the cardiac structure and function are still divided.Objectives:Monitoring seven days dynamic electrocardiogram, analysis patients seven days PVCs burdern, recorded echocardiography and serum N-terminal pro-brain-type natriuretic peptide (NT-proBNP) test results. To explore how do different origin site and different burdern PVCs influence serum NT-proBNP level and cardiac structure and function.Methods:From May 2012 to April 2013,101 cases PVCs patients come from cardiovascular clinic and ward of the Jiangsu Province People’s Hospital. Collectting the basic information of the patients, all patients underwent physical examination to exclude related diseases,12-lead ECG,7 days Holter monitoring, if necessary, some patients underwent cardiac electrophysiology examination or coronary angiography. Two-dimensional echocardiography was took to measurement left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) value. Serum N-terminal pro-brain-type natriuretic peptide (NT-proBNP) levels was also detected.Results:The NT-proBNP concentration, LVESD and LVEDD origin from the right ventricle (RVOT, the origin of the tricuspid annulus and the great cardiac vein) were less than the left ventricular (LVOT and bicuspid valve), LVEF is contrast, however, P>0.05. PVCs buedern showed a positive correlation of the NT-proBNP and LVEDD(r=0.237,0.394, P<0.05)Conclusion:Compared with right ventricular origin, premature ventricular contractions origin from the left ventricular have higer influence about cardiac structure and function, but the difference was not statistically significant, a larger sample size need to be take study. Idiopathic premature ventricular contractions with small burdern is benign relatively, has less impact on cardiac structure and function, as premature ventricular contractions burdern gradually increases, it will lead to the reconstruction of cardiac structure and function. High-burdern PVCs patients need long-term follow-up to rule out underlying cardiac disease.Part III:The relationship between the quality of life and the premature ventricular contractionsBackground:Premature ventricular contractions does not directly life-threatening, but the onset of clinical symptoms (such as palpitations, chest pain, syncope, etc.) affect the patients’ quality of life seriously for the patients with ventricular premature, severe cases can lead to arrhythmogenic cardiomyopathy and increased the risk of sudden death. Health-related QoL is a comprehensive index system to evaluate the efficacy, disease outcome and treatment outcomes, it gets more and more people’s attention.Objective:Monitoring seven days dynamic echocardiography, evaluation PVCs patients’quality of life, analyze its impact factors, in order to provide a more comprehensive basis for the treatment to improve the quality of life of PVCs patients.Methods:Self-made general questionnaire and the EQ-5D scale were apllied to the PVCs patients come from the First Affiliated Hospital of Nanjing Medical University.Collectting patient’s demographics, taking history of all patients, taking physical examination,12-lead ECG,7-day Holter monitoring.Results:The ratio which PVCs patients answered no problem in the EQ-5D dimension were lower than the general population, daily activities, pain/discomfort, anxiety/depression dimension differences were statistically significant (P<0.01). VAS score (75.63±15.31) was lower than the general population (83.00±12.700) (P <0.05). There was no significant difference (P> 0.05) in EQ-5D dimension between different originating grouping patients with ventricular premature. Regression analysis showed that gender, educational level, and burdern group were influencing factors of VAS.Conclusions:The quality of life of patients with ventricular premature was lower than the general population. Gender, educational level and ventricular premature burdern were factors affecting the quality of the the PVCs. It indicates that Medical personnel should be strengthened health education on women and low education patients in clinical work. The burdern is greater than 20% recommended surgery for patients with ventricular premature.