Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: Two-year findings from the Oregon sudden unexpected death study

Eric Stecker, Catherine Vickers, Justin Waltz, Carmen Socoteanu, Benjamin T. John, Ronald Mariani, John H. McAnulty, Karen Gunson, Jonathan Jui, Sumeet S. Chugh

Research output: Contribution to journalArticle

293 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1161-1166
Number of pages6
JournalJournal of the American College of Cardiology
Volume47
Issue number6
DOIs
StatePublished - Mar 21 2006

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Sudden Cardiac Death
Left Ventricular Dysfunction
Sudden Death
Population
Left Ventricular Function
Defibrillators
Stroke Volume
Signs and Symptoms
Coronary Artery Disease
Epilepsy
Incidence

ASJC Scopus subject areas

  • Nursing(all)

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Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction : Two-year findings from the Oregon sudden unexpected death study. / Stecker, Eric; Vickers, Catherine; Waltz, Justin; Socoteanu, Carmen; John, Benjamin T.; Mariani, Ronald; McAnulty, John H.; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S.

In: Journal of the American College of Cardiology, Vol. 47, No. 6, 21.03.2006, p. 1161-1166.

Research output: Contribution to journalArticle

Stecker, Eric ; Vickers, Catherine ; Waltz, Justin ; Socoteanu, Carmen ; John, Benjamin T. ; Mariani, Ronald ; McAnulty, John H. ; Gunson, Karen ; Jui, Jonathan ; Chugh, Sumeet S. / Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction : Two-year findings from the Oregon sudden unexpected death study. In: Journal of the American College of Cardiology. 2006 ; Vol. 47, No. 6. pp. 1161-1166.
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title = "Population-based analysis of sudden cardiac death with and without left ventricular systolic dysfunction: Two-year findings from the Oregon sudden unexpected death study",
abstract = "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.",
author = "Eric Stecker and Catherine Vickers and Justin Waltz and Carmen Socoteanu and John, {Benjamin T.} and Ronald Mariani and McAnulty, {John H.} and Karen Gunson and Jonathan Jui and Chugh, {Sumeet S.}",
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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

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.

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.

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