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J Am Coll Cardiol, 2006; 47:1161-1166, doi:10.1016/j.jacc.2005.11.045 (Published online 21 February 2006).
© 2006 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: LV FUNCTION AND RISK

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 C. Stecker, MD, Catherine Vickers, RN, Justin Waltz, MPH, Carmen Socoteanu, MD, Benjamin T. John, MD, Ronald Mariani, EMT-P, John H. McAnulty, MD, FACC, Karen Gunson, MD, Jonathan Jui, MD, MPH and Sumeet S. Chugh, MD, FACC*

Heart Rhythm Research Laboratory, Division of Cardiology, Oregon Health and Science University, Portland, Oregon

Manuscript received September 4, 2005; revised manuscript received October 17, 2005, accepted November 20, 2005.

* Reprint requests and correspondence: Dr. Sumeet S. Chugh, Cardiology Division, UHN-62, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239. (Email: chughs{at}ohsu.edu).

Presented in part at the American College of Cardiology 2005 Annual Scientific Sessions (2005 Young Investigator Award to ECS for this manuscript).

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.

Abbreviations and Acronyms
  ARVD = arrhythmogenic right ventricular dysplasia
  CAD = coronary artery disease
  ICD = implantable cardioverter-defibrillator
  LV = left ventricular
  LVEF = left ventricular ejection fraction
  MI = myocardial infarction
  SCD = sudden cardiac death


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