untitled protocol v1
Authors: WNR Ribeiro Wilma , yamada Alice , grupi Cesar , silva gisela , Mansur Alfredo 
Published: July 2018

Premature complexes are common findings in outpatients; thus, it is important to evaluate their clinical significance and related factors. The aim of our study was to evaluate the variables associated with premature beats identified in outpatients referred from a primary care facility. Methods – We performed a cross-sectional study of 407 outpatients (55.8±11years; 56% women) who were followed by general practitioners and referred for resting 12-lead electrocardiograms for clinical follow-up. They answered a questionnaire and submitted physical examinations, fasting laboratory testing, transthoracic echocardiograms and 24-hour Holter monitoring, which were used to categorize the frequency of premature complexes. After the univariate analysis, logistic regression analyses were performed with adjustment for age, sex, and cardiovascular diseases. Results – Premature atrial complexes (≥ 4/hour) were associated with age (OR 1.030, 95%CI 1.002─1.059, p=0.029), brain natriuretic peptide (BNP) levels > 20mg/dL (OR 4.489, 95%CI 1.918─10.507, p=0.0005), intraventricular blocks (OR 4.184, 95%CI 1.816─9.406, p=0.0005) and left atrial diameter (OR 1.065, 95%CI 1.001─1.134, p=0.046). Premature ventricular complexes (≥ 5/hour) were related to age (OR 1.032, 95%CI 1.010─1.054, p=0.004), the use of calcium channel blockers (OR 2.248, 95%CI 1.019─4.954, p=0.045), HDL-cholesterol levels (OR 0.971, 95%CI 0.951─0.992, p=0.007), BNP levels > 20mg/dL (OR 2.079, 95%CI 0.991─0.998, p=0.033), heart rate (OR 1.019, 95%CI 1.001─1.038, p=0.041), left ventricular hypertrophy (OR 2.292, 95%CI 1.402─3.746, p=0.001) and left ventricular ejection fraction (OR 0.938, 95%CI 0.900─0.978, p=0.002). Conclusion – Frequent premature complexes were associated with BNP levels > 20mg/dL and lower levels of HDL-cholesterol; left atrial enlargement and ventricular hypertrophy were also identified on the echocardiograms of these patients, suggesting that target organ damage was due to uncontrolled arterial hypertension. Therefore, the identification of frequent premature complexes on 24-hour Holter monitor recordings of outpatients in a primary public healthcare setting reaffirms the need for monitoring for the risk factors associated with this finding. Premature complexes are common findings in outpatients; thus, it is important to evaluate their clinical significance and related factors. The aim of our study was to evaluate the variables associated with premature beats identified in outpatients referred from a primary care facility. Methods – We performed a cross-sectional study of 407 outpatients (55.8±11years; 56% women) who were followed by general practitioners and referred for resting 12-lead electrocardiograms for clinical follow-up. They answered a questionnaire and submitted physical examinations, fasting laboratory testing, transthoracic echocardiograms and 24-hour Holter monitoring, which were used to categorize the frequency of premature complexes. After the univariate analysis, logistic regression analyses were performed with adjustment for age, sex, and cardiovascular diseases. Results – Premature atrial complexes (≥ 4/hour) were associated with age (OR 1.030, 95%CI 1.002─1.059, p=0.029), brain natriuretic peptide (BNP) levels > 20mg/dL (OR 4.489, 95%CI 1.918─10.507, p=0.0005), intraventricular blocks (OR 4.184, 95%CI 1.816─9.406, p=0.0005) and left atrial diameter (OR 1.065, 95%CI 1.001─1.134, p=0.046). Premature ventricular complexes (≥ 5/hour) were related to age (OR 1.032, 95%CI 1.010─1.054, p=0.004), the use of calcium channel blockers (OR 2.248, 95%CI 1.019─4.954, p=0.045), HDL-cholesterol levels (OR 0.971, 95%CI 0.951─0.992, p=0.007), BNP levels > 20mg/dL (OR 2.079, 95%CI 0.991─0.998, p=0.033), heart rate (OR 1.019, 95%CI 1.001─1.038, p=0.041), left ventricular hypertrophy (OR 2.292, 95%CI 1.402─3.746, p=0.001) and left ventricular ejection fraction (OR 0.938, 95%CI 0.900─0.978, p=0.002). Conclusion – Frequent premature complexes were associated with BNP levels > 20mg/dL and lower levels of HDL-cholesterol; left atrial enlargement and ventricular hypertrophy were also identified on the echocardiograms of these patients, suggesting that target organ damage was due to uncontrolled arterial hypertension. Therefore, the identification of frequent premature complexes on 24-hour Holter monitor recordings of outpatients in a primary public healthcare setting reaffirms the need for monitoring for the risk factors associated with this finding.