TY - JOUR
T1 - Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction
T2 - Two-year findings from the Oregon sudden unexpected death study
AU - Stecker, Eric C.
AU - Vickers, Catherine
AU - Waltz, Justin
AU - Socoteanu, Carmen
AU - John, Benjamin T.
AU - Mariani, Ronald
AU - McAnulty, John H.
AU - Gunson, Karen
AU - Jui, Jonathan
AU - Chugh, Sumeet S.
N1 - Funding Information:
Dr. Chugh is supported by the United States Centers for Disease Control and Prevention/ATPM TS-0660, the Donald W. Reynolds Clinical Cardiovascular Research Center Grant to Johns Hopkins University, NHLBI HL-04-001, and PHS Grant 5 M01 RR000334. Drs. Stecker and John are recipients of postdoctoral fellowship awards from the American Heart Association.
PY - 2006/3/21
Y1 - 2006/3/21
N2 - OBJECTIVES: We sought to evaluate the contribution of left ventricular (LV) dysfunction toward occurrence of sudden cardiac death (SCD) in the general population, and to identify distinguishing characteristics of SCD in the absence of LV dysfunction. BACKGROUND: Patients who manifest warning symptoms and signs are more likely to undergo evaluation before SCD. Although prevalence of LV dysfunction in this subgroup may overestimate the prevalence in overall SCD, this is the only means of assessment in the general population. METHODS: All cases of SCD in Multnomah County, Oregon (population 660,486; 2002 to 2004) were prospectively ascertained in the ongoing Oregon Sudden Unexpected Death Study. We retrospectively assessed LV ejection fraction (LVEF) among subjects who underwent evaluation of LV function before SCD (normal: ≥55%; mildly to moderately reduced: 36% to 54%; and severely reduced: ≤35%). Of a total of 714 SCD cases (annual incidence 54 per 100,000), LV function was assessed in 121 (17%). RESULTS: The LVEF was severely reduced in 36 patients (30%), mildly to moderately reduced in 27 (22%), and normal in 58 (48%). Patients with normal LVEF were distinguishable by younger age (66 ± 15 years vs. 74 ± 10 years; p = 0.001), higher proportion of females (47% vs. 27%; p = 0.025), higher prevalence of seizure disorder (14% vs. 0%; p = 0.002), and lower prevalence of established coronary artery disease (50% vs. 81%; p < 0.001). CONCLUSIONS: In this community-wide study, only one-third of the evaluated SCD cases had severe LV dysfunction meeting current criteria for prophylactic cardioverter-defibrillator implantation. The SCD cases with normal LV function had several distinguishing clinical characteristics. These findings support the aggressive development of alternative screening methods to enhance identification of patients at risk.
AB - OBJECTIVES: We sought to evaluate the contribution of left ventricular (LV) dysfunction toward occurrence of sudden cardiac death (SCD) in the general population, and to identify distinguishing characteristics of SCD in the absence of LV dysfunction. BACKGROUND: Patients who manifest warning symptoms and signs are more likely to undergo evaluation before SCD. Although prevalence of LV dysfunction in this subgroup may overestimate the prevalence in overall SCD, this is the only means of assessment in the general population. METHODS: All cases of SCD in Multnomah County, Oregon (population 660,486; 2002 to 2004) were prospectively ascertained in the ongoing Oregon Sudden Unexpected Death Study. We retrospectively assessed LV ejection fraction (LVEF) among subjects who underwent evaluation of LV function before SCD (normal: ≥55%; mildly to moderately reduced: 36% to 54%; and severely reduced: ≤35%). Of a total of 714 SCD cases (annual incidence 54 per 100,000), LV function was assessed in 121 (17%). RESULTS: The LVEF was severely reduced in 36 patients (30%), mildly to moderately reduced in 27 (22%), and normal in 58 (48%). Patients with normal LVEF were distinguishable by younger age (66 ± 15 years vs. 74 ± 10 years; p = 0.001), higher proportion of females (47% vs. 27%; p = 0.025), higher prevalence of seizure disorder (14% vs. 0%; p = 0.002), and lower prevalence of established coronary artery disease (50% vs. 81%; p < 0.001). CONCLUSIONS: In this community-wide study, only one-third of the evaluated SCD cases had severe LV dysfunction meeting current criteria for prophylactic cardioverter-defibrillator implantation. The SCD cases with normal LV function had several distinguishing clinical characteristics. These findings support the aggressive development of alternative screening methods to enhance identification of patients at risk.
UR - http://www.scopus.com/inward/record.url?scp=33644903761&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33644903761&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2005.11.045
DO - 10.1016/j.jacc.2005.11.045
M3 - Article
C2 - 16545646
AN - SCOPUS:33644903761
SN - 0735-1097
VL - 47
SP - 1161
EP - 1166
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 6
ER -