Left-ventricular geometry and risk of sudden cardiac arrest in patients with preserved or moderately reduced left-ventricular ejection fraction

Aapo L. Aro, Kyndaron Reinier, Derek Phan, Carmen Teodorescu, Audrey Uy-Evanado, Gregory A. Nichols, Karen Gunson, Jonathan Jui, Sumeet S. Chugh

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12 Scopus citations

Abstract

Aims The majority of sudden cardiac arrests (SCAs) occur in patients with left-ventricular (LV) ejection fraction (LVEF) >35%, yet there are no methods for effective risk stratification in this sub-group. Since abnormalities of LV geometry can be identified even with preserved LVEF, we investigated the potential impact of LV geometry as a novel risk marker for this patient population. Methods and results In the ongoing Oregon Sudden Unexpected Death Study, SCA cases with archived echocardiographic data available were prospectively identified during 2002-15, and compared with geographical controls. Analysis was restricted to subjects with LVEF >35%. Based on established measures of LV mass and relative wall thickness (ratio of wall thickness to cavity diameter), four different LV geometric patterns were identified: normal geometry, concentric remodelling, concentric hypertrophy, and eccentric hypertrophy. Sudden cardiac arrest cases (n = 307) and controls (n = 280) did not differ in age, sex, or LVEF, but increased LV mass was more common in cases. Twenty-nine percent of SCA cases presented with normal LV geometry, 35% had concentric remodelling, 25% concentric hypertrophy, and 11% eccentric hypertrophy. In multivariate model, concentric remodelling (OR 1.76; 95%CI 1.18-2.63; P = 0.005), concentric hypertrophy (OR 3.20; 95%CI 1.90-5.39; P < 0.001), and eccentric hypertrophy (OR 2.47; 95%CI 1.30-4.66; P = 0.006) were associated with increased risk of SCA. Conclusion Concentric and eccentric LV hypertrophy, but also concentric remodelling without hypertrophy, are associated with increased risk of SCA. These novel findings suggest the potential utility of evaluating LV geometry as a potential risk stratification tool in patients with preserved or moderately reduced LVEF.

Original languageEnglish (US)
Pages (from-to)1146-1152
Number of pages7
JournalEuropace
Volume19
Issue number7
DOIs
StatePublished - Jul 1 2017

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Keywords

  • Concentric remodelling
  • Echocardiography
  • Left ventricular geometry
  • Left-ventricular hypertrophy
  • Sudden cardiac arrest

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Aro, A. L., Reinier, K., Phan, D., Teodorescu, C., Uy-Evanado, A., Nichols, G. A., Gunson, K., Jui, J., & Chugh, S. S. (2017). Left-ventricular geometry and risk of sudden cardiac arrest in patients with preserved or moderately reduced left-ventricular ejection fraction. Europace, 19(7), 1146-1152. https://doi.org/10.1093/europace/euw126