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Left ventricular diameter and risk stratification for sudden cardiac death
Journal article   Open access

Left ventricular diameter and risk stratification for sudden cardiac death

Kumar Narayanan, Kyndaron Reinier, Carmen Teodorescu, Audrey Uy-Evanado, Ryan Aleong, Harpriya Chugh, Gregory A Nichols, Karen Gunson, Barry London, Jonathan Jui, …
Journal of the American Heart Association, Vol.3(5), pp.e001193-n/a
09/16/2014
DOI: 10.1161/JAHA.114.001193
PMCID: PMC4323796
PMID: 25227407
url
https://doi.org/10.1161/JAHA.114.001193View
Published (Version of record) Open Access

Abstract

Left ventricular (LV) diameter is routinely measured on the echocardiogram but has not been jointly evaluated with the ejection fraction (EF) for risk stratification of sudden cardiac death (SCD). From a large ongoing community-based study of SCD (The Oregon Sudden Unexpected Death Study; population ≈1 million), SCD cases were compared with geographic controls. LVEF and LV diameter, measured using the LV internal dimension in diastole (categorized as normal, mild, moderate, or severe dilatation using American Society of Echocardiography definitions) were assessed from echocardiograms prior but unrelated to the SCD event. Cases (n=418; 69.5±13.8 years), compared with controls (n=329; 67.7±11.9 years), more commonly had severe LV dysfunction (EF ≤35%; 30.5% versus 18.8%; P<0.01) and larger LV diameter (52.2±10.5 mm versus 49.7±7.9 mm; P<0.01). Moderate or severe LV dilatation (16.3% versus 8.2%; P=0.001) and severe LV dilatation (8.1% versus 2.1%; P<0.001) were significantly more frequent in cases. In multivariable analysis, severe LV dilatation was an independent predictor of SCD (odds ratio 2.5 [95% CI 1.03 to 5.9]; P=0.04). In addition, subjects with both EF ≤35% and severe LV dilatation had higher odds for SCD compared with those with low EF only (odds ratio 3.8 [95% CI 1.5 to 10.2] for both versus 1.7 [95% CI 1.2 to 2.5] for low EF only), suggesting that severe LV dilatation additively increased SCD risk. LV diameter may contribute to risk stratification for SCD independent of the LVEF. This readily available echocardiographic measure warrants further prospective evaluation.
 Age Distribution Aged Aged, 80 and over Case-Control Studies Cause of Death Death, Sudden, Cardiac - epidemiology Echocardiography, Doppler Female Follow-Up Studies Heart Ventricles - diagnostic imaging Heart Ventricles - physiopathology Humans Male Middle Aged Reference Values Retrospective Studies Risk Assessment Sex Distribution Stroke Volume - physiology Ventricular Dysfunction, Left - diagnostic imaging Ventricular Dysfunction, Left - mortality Ventricular Dysfunction, Left - physiopathology

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