title: Subclinical Abnormalities in Echocardiographic Parameters and Risk of Sudden Cardiac Death in a General Population: The Rotterdam Study.
abstract: BACKGROUND
  Subclinical cardiac dysfunction has been associated with increased mortality, and heart failure increases the risk of sudden cardiac death (SCD). Less well known is whether subclinical cardiac dysfunction is also a risk factor for SCD. Our objective was to assess the association between echocardiographic parameters and SCD in a community-dwelling population free of heart failure.
  
  
  RESULTS
  We computed hazard ratios (HRs) for left atrium diameter, left ventricular (LV) end-diastolic dimension, LV end-systolic dimension, LV mass, qualitative LV systolic function, LV fractional shortening, and diastolic function. During a median follow-up of 6.3 years in 4,686 participants, 68 participants died because of SCD. Significant associations with SCD were observed for qualitative LV systolic function and LV fractional shortening. For moderate/poor qualitative LV systolic function, the HR for SCD was 2.54 (95% confidence interval [CI] 1.10-5.87). Each standard deviation decrease in LV fractional shortening was associated with an HR of 1.36 (95% CI 1.09-1.70).
  
  
  CONCLUSIONS
  Subclinical abnormalities in LV systolic function were associated with SCD risk in this general population. Although prediction of SCD remains difficult and traditional cardiovascular risk factors are of greatest importance, this knowledge might guide future directions to prevent SCD in persons with subclinical cardiac dysfunction.
authors.affiliation: Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Maartje N
authors.initials: MN
authors.lastname: Niemeijer
authors.affiliation: Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Maarten J G
authors.initials: MJ
authors.lastname: Leening
authors.affiliation: Department of Medical Informatics, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Marten E
authors.initials: ME
authors.lastname: van den Berg
authors.affiliation: Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
authors.affiliation: Department of Cardiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Deckers
authors.affiliation: Department of Medical Informatics, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Rijnbeek
authors.affiliation: Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands; Inspectorate of Health Care, Utrecht, The Netherlands. Electronic address: b.stricker@erasmusmc.nl.
authors.forename: Bruno H
authors.initials: BH
authors.lastname: Stricker
authors.affiliation: Department of Epidemiology, Erasmus Medical Center-University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: Eijgelsheim
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000453:epidemiology*
keywords: Sudden cardiac death; echocardiography; epidemiology; heart failure