Left Ventricular Geometry and Risk of Sudden Cardiac Arrest in Patients With Severely Reduced Ejection Fraction

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

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

BACKGROUND: Recent reports indicate that specific left ventricular (LV) geometric patterns predict recurrent ventricular arrhythmias in patients with implantable cardioverter-defibrillators and reduced left ventricular ejection fraction (LVEF). However, this relationship has not been evaluated among patients at risk of sudden cardiac arrest (SCA) in the general population.

METHODS AND RESULTS: Adult SCA cases from the Oregon Sudden Unexpected Death Study were compared with geographic controls with no prior history of SCA. Archived echocardiograms performed closest and prior to the SCA event were reviewed. LV geometry was defined as normal (normal LV mass index [LVMI] and relative wall thickness [RWT]), concentric remodeling (normal LVMI and increased RWT), concentric hypertrophy (increased LVMI and RWT), or eccentric hypertrophy (increased LVMI and normal RWT). Analysis was restricted to those with LVEF ≤40%. A total of 246 subjects were included in the analysis. SCA cases (n=172, 68.6±13.3 years, 78% male), compared to controls (n=74, 66.8±12.1 years, 73% male), had lower LVEF (29.4±7.9% vs 30.8±6.3%, P=0.021). Fewer cases presented with normal LV geometry (30.2% vs 43.2%, P=0.048) and more with eccentric hypertrophy (40.7% vs 25.7%, P=0.025). In a multivariate model, eccentric hypertrophy was independently predictive of SCA (OR 2.15, 95% CI 1.08-4.29, P=0.03).

CONCLUSIONS: Eccentric LV hypertrophy was independently associated with increased risk of SCA in subjects with EF ≤40%. These findings, now consistent between device-implanted and non-implanted populations, indicate the potential of improving SCA risk stratification from the same noninvasive echocardiogram at no additional cost.

Original languageEnglish (US)
JournalJournal of the American Heart Association
Volume5
Issue number8
StatePublished - Aug 18 2016

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Sudden Cardiac Death
Hypertrophy
Stroke Volume
Implantable Defibrillators
Left Ventricular Hypertrophy
Sudden Death
Population
Cardiac Arrhythmias
Costs and Cost Analysis
Equipment and Supplies

Keywords

  • eccentric hypertrophy
  • left ventricular geometry
  • sudden cardiac arrest

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Phan, D., Aro, A. L., Reinier, K., Teodorescu, C., Uy-Evanado, A., Gunson, K., ... Chugh, S. S. (2016). Left Ventricular Geometry and Risk of Sudden Cardiac Arrest in Patients With Severely Reduced Ejection Fraction. Journal of the American Heart Association, 5(8).

Left Ventricular Geometry and Risk of Sudden Cardiac Arrest in Patients With Severely Reduced Ejection Fraction. / Phan, Derek; Aro, Aapo L.; Reinier, Kyndaron; Teodorescu, Carmen; Uy-Evanado, Audrey; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S.

In: Journal of the American Heart Association, Vol. 5, No. 8, 18.08.2016.

Research output: Contribution to journalArticle

Phan, D, Aro, AL, Reinier, K, Teodorescu, C, Uy-Evanado, A, Gunson, K, Jui, J & Chugh, SS 2016, 'Left Ventricular Geometry and Risk of Sudden Cardiac Arrest in Patients With Severely Reduced Ejection Fraction', Journal of the American Heart Association, vol. 5, no. 8.
Phan, Derek ; Aro, Aapo L. ; Reinier, Kyndaron ; Teodorescu, Carmen ; Uy-Evanado, Audrey ; Gunson, Karen ; Jui, Jonathan ; Chugh, Sumeet S. / Left Ventricular Geometry and Risk of Sudden Cardiac Arrest in Patients With Severely Reduced Ejection Fraction. In: Journal of the American Heart Association. 2016 ; Vol. 5, No. 8.
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abstract = "BACKGROUND: Recent reports indicate that specific left ventricular (LV) geometric patterns predict recurrent ventricular arrhythmias in patients with implantable cardioverter-defibrillators and reduced left ventricular ejection fraction (LVEF). However, this relationship has not been evaluated among patients at risk of sudden cardiac arrest (SCA) in the general population.METHODS AND RESULTS: Adult SCA cases from the Oregon Sudden Unexpected Death Study were compared with geographic controls with no prior history of SCA. Archived echocardiograms performed closest and prior to the SCA event were reviewed. LV geometry was defined as normal (normal LV mass index [LVMI] and relative wall thickness [RWT]), concentric remodeling (normal LVMI and increased RWT), concentric hypertrophy (increased LVMI and RWT), or eccentric hypertrophy (increased LVMI and normal RWT). Analysis was restricted to those with LVEF ≤40{\%}. A total of 246 subjects were included in the analysis. SCA cases (n=172, 68.6±13.3 years, 78{\%} male), compared to controls (n=74, 66.8±12.1 years, 73{\%} male), had lower LVEF (29.4±7.9{\%} vs 30.8±6.3{\%}, P=0.021). Fewer cases presented with normal LV geometry (30.2{\%} vs 43.2{\%}, P=0.048) and more with eccentric hypertrophy (40.7{\%} vs 25.7{\%}, P=0.025). In a multivariate model, eccentric hypertrophy was independently predictive of SCA (OR 2.15, 95{\%} CI 1.08-4.29, P=0.03).CONCLUSIONS: Eccentric LV hypertrophy was independently associated with increased risk of SCA in subjects with EF ≤40{\%}. These findings, now consistent between device-implanted and non-implanted populations, indicate the potential of improving SCA risk stratification from the same noninvasive echocardiogram at no additional cost.",
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AU - Phan, Derek

AU - Aro, Aapo L.

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AU - Teodorescu, Carmen

AU - Uy-Evanado, Audrey

AU - Gunson, Karen

AU - Jui, Jonathan

AU - Chugh, Sumeet S.

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N2 - BACKGROUND: Recent reports indicate that specific left ventricular (LV) geometric patterns predict recurrent ventricular arrhythmias in patients with implantable cardioverter-defibrillators and reduced left ventricular ejection fraction (LVEF). However, this relationship has not been evaluated among patients at risk of sudden cardiac arrest (SCA) in the general population.METHODS AND RESULTS: Adult SCA cases from the Oregon Sudden Unexpected Death Study were compared with geographic controls with no prior history of SCA. Archived echocardiograms performed closest and prior to the SCA event were reviewed. LV geometry was defined as normal (normal LV mass index [LVMI] and relative wall thickness [RWT]), concentric remodeling (normal LVMI and increased RWT), concentric hypertrophy (increased LVMI and RWT), or eccentric hypertrophy (increased LVMI and normal RWT). Analysis was restricted to those with LVEF ≤40%. A total of 246 subjects were included in the analysis. SCA cases (n=172, 68.6±13.3 years, 78% male), compared to controls (n=74, 66.8±12.1 years, 73% male), had lower LVEF (29.4±7.9% vs 30.8±6.3%, P=0.021). Fewer cases presented with normal LV geometry (30.2% vs 43.2%, P=0.048) and more with eccentric hypertrophy (40.7% vs 25.7%, P=0.025). In a multivariate model, eccentric hypertrophy was independently predictive of SCA (OR 2.15, 95% CI 1.08-4.29, P=0.03).CONCLUSIONS: Eccentric LV hypertrophy was independently associated with increased risk of SCA in subjects with EF ≤40%. These findings, now consistent between device-implanted and non-implanted populations, indicate the potential of improving SCA risk stratification from the same noninvasive echocardiogram at no additional cost.

AB - BACKGROUND: Recent reports indicate that specific left ventricular (LV) geometric patterns predict recurrent ventricular arrhythmias in patients with implantable cardioverter-defibrillators and reduced left ventricular ejection fraction (LVEF). However, this relationship has not been evaluated among patients at risk of sudden cardiac arrest (SCA) in the general population.METHODS AND RESULTS: Adult SCA cases from the Oregon Sudden Unexpected Death Study were compared with geographic controls with no prior history of SCA. Archived echocardiograms performed closest and prior to the SCA event were reviewed. LV geometry was defined as normal (normal LV mass index [LVMI] and relative wall thickness [RWT]), concentric remodeling (normal LVMI and increased RWT), concentric hypertrophy (increased LVMI and RWT), or eccentric hypertrophy (increased LVMI and normal RWT). Analysis was restricted to those with LVEF ≤40%. A total of 246 subjects were included in the analysis. SCA cases (n=172, 68.6±13.3 years, 78% male), compared to controls (n=74, 66.8±12.1 years, 73% male), had lower LVEF (29.4±7.9% vs 30.8±6.3%, P=0.021). Fewer cases presented with normal LV geometry (30.2% vs 43.2%, P=0.048) and more with eccentric hypertrophy (40.7% vs 25.7%, P=0.025). In a multivariate model, eccentric hypertrophy was independently predictive of SCA (OR 2.15, 95% CI 1.08-4.29, P=0.03).CONCLUSIONS: Eccentric LV hypertrophy was independently associated with increased risk of SCA in subjects with EF ≤40%. These findings, now consistent between device-implanted and non-implanted populations, indicate the potential of improving SCA risk stratification from the same noninvasive echocardiogram at no additional cost.

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