Functional classification of extrasystoles based on hemodynamic features and risk of arterial vascular complications

Abstract

Aim: To develop a functional classification of extrasystoles (ES) based on cardiac biomechanics, arterial hemodynamics and kinetics, and the associated risk of arterial vascular events.

Materials and methods: This monocentric, prospective study included 634 patients with ≥ 700 ES per 24 h. The control group consisted of 106 patients with < 700 ES per 24 h. The main group was divided into two subgroups, A and B, according to the identified ES variant, categorized by the timing of ES ventricular systole within the cardiac cycle, independent of the ectopic focus location. Standard instrumental and laboratory assessments were performed. The prospective follow-up period was one year, with evaluations at 6 and 12 months. The composite endpoint was the occurrence of ischemic vascular events.

Results: Patients with ≥ 700 ES per 24 h had a significantly higher incidence of arterial vascular complications within 1 year, particularly those in subgroup A. The first postextrasystolic wave was characterized by an increase in hemodynamic parameters, especially in early ES occurring before the transmitral blood flow peak (E wave) on echocardiography.

Conclusions: Considering the impact on hemodynamics and the differences in ischemic vascular event rates (including cerebral ischemic events, myocardial infarction, and embolic events in other vascular territories), ES can reasonably be classified based on the timing of ventricular systole within the cardiac cycle: ES with ventricular systole occurring before the transmitral blood flow peak, and ES with ventricular systole occurring after the transmitral blood flow peak.

Keywords

Premature complexes / extrasystole / arterial hemodynamics / classification of extrasystoles / cardiac biomechanics / arterial kinetics

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