title: Left-ventricular geometry and risk of sudden cardiac arrest in patients with preserved or moderately reduced left-ventricular ejection fraction.
abstract: OBJECTIVE
  The majority of sudden cardiac arrests (SCAs) occur in patients with left-ventricular (LV) ejection fraction (LVEF) >35%, yet there are no methods for effective risk stratification in this sub-group. Since abnormalities of LV geometry can be identified even with preserved LVEF, we investigated the potential impact of LV geometry as a novel risk marker for this patient population.
  
  
  RESULTS
  In the ongoing Oregon Sudden Unexpected Death Study, SCA cases with archived echocardiographic data available were prospectively identified during 2002-15, and compared with geographical controls. Analysis was restricted to subjects with LVEF >35%. Based on established measures of LV mass and relative wall thickness (ratio of wall thickness to cavity diameter), four different LV geometric patterns were identified: normal geometry, concentric remodelling, concentric hypertrophy, and eccentric hypertrophy. Sudden cardiac arrest cases (n = 307) and controls (n = 280) did not differ in age, sex, or LVEF, but increased LV mass was more common in cases. Twenty-nine percent of SCA cases presented with normal LV geometry, 35% had concentric remodelling, 25% concentric hypertrophy, and 11% eccentric hypertrophy. In multivariate model, concentric remodelling (OR 1.76; 95%CI 1.18-2.63; P = 0.005), concentric hypertrophy (OR 3.20; 95%CI 1.90-5.39; P < 0.001), and eccentric hypertrophy (OR 2.47; 95%CI 1.30-4.66; P = 0.006) were associated with increased risk of SCA.
  
  
  CONCLUSIONS
  Concentric and eccentric LV hypertrophy, but also concentric remodelling without hypertrophy, are associated with increased risk of SCA. These novel findings suggest the potential utility of evaluating LV geometry as a potential risk stratification tool in patients with preserved or moderately reduced LVEF.
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA.|Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Aapo L
authors.initials: AL
authors.lastname: Aro
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA.
authors.forename: Kyndaron
authors.initials: K
authors.lastname: Reinier
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Phan
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA.
authors.forename: Carmen
authors.initials: C
authors.lastname: Teodorescu
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA.
authors.forename: Audrey
authors.initials: A
authors.lastname: Uy-Evanado
authors.affiliation: Kaiser Permanente Center for Health Research, Portland, OR, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Nichols
authors.affiliation: Oregon Health and Science University, Portland, OR, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Gunson
authors.affiliation: Oregon Health and Science University, Portland, OR, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jui
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Suite A3100, 127 S. San Vicente Blvd., Los Angeles, CA 90048, USA.
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004452:Echocardiography; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009922:Oregon; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: Concentric remodelling; Echocardiography; Left ventricular geometry; Left-ventricular hypertrophy; Sudden cardiac arrest