title: Left Ventricular Geometry and Risk of Sudden Cardiac Arrest in Patients With Severely Reduced Ejection Fraction.
abstract: Recent reports indicate that specific left ventricular (LV) geometric patterns predict recurrent ventricular arrhythmias in patients with implantable cardioverter-defibrillators and reduced left ventricular ejection fraction (LVEF). However, this relationship has not been evaluated among patients at risk of sudden cardiac arrest (SCA) in the general population.
  
  
  
  Adult SCA cases from the Oregon Sudden Unexpected Death Study were compared with geographic controls with no prior history of SCA. Archived echocardiograms performed closest and prior to the SCA event were reviewed. LV geometry was defined as normal (normal LV mass index [LVMI] and relative wall thickness [RWT]), concentric remodeling (normal LVMI and increased RWT), concentric hypertrophy (increased LVMI and RWT), or eccentric hypertrophy (increased LVMI and normal RWT). Analysis was restricted to those with LVEF ≤40%. A total of 246 subjects were included in the analysis. SCA cases (n=172, 68.6±13.3 years, 78% male), compared to controls (n=74, 66.8±12.1 years, 73% male), had lower LVEF (29.4±7.9% vs 30.8±6.3%, P=0.021). Fewer cases presented with normal LV geometry (30.2% vs 43.2%, P=0.048) and more with eccentric hypertrophy (40.7% vs 25.7%, P=0.025). In a multivariate model, eccentric hypertrophy was independently predictive of SCA (OR 2.15, 95% CI 1.08-4.29, P=0.03).
  
  
  
  Eccentric LV hypertrophy was independently associated with increased risk of SCA in subjects with EF ≤40%. These findings, now consistent between device-implanted and non-implanted populations, indicate the potential of improving SCA risk stratification from the same noninvasive echocardiogram at no additional cost.
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Derek
authors.initials: D
authors.lastname: Phan
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.|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, Los Angeles, CA.
authors.forename: Kyndaron
authors.initials: K
authors.lastname: Reinier
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Carmen
authors.initials: C
authors.lastname: Teodorescu
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Audrey
authors.initials: A
authors.lastname: Uy-Evanado
authors.affiliation: Oregon Health and Science University, Portland, OR.
authors.forename: Karen
authors.initials: K
authors.lastname: Gunson
authors.affiliation: Oregon Health and Science University, Portland, OR.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jui
authors.affiliation: Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA sumeet.chugh@cshs.org.
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology* / Q000473:pathology; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left
keywords: eccentric hypertrophy; left ventricular geometry; sudden cardiac arrest