An association between right ventricular dysfunction and sudden cardiac death.
Summit Pandat1, Takafumi Nagaura1, Sandeep G Nair1
1Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Heart Rhythm
|October 22, 2019
Summary
Right ventricular dysfunction significantly increases sudden cardiac death risk, independent of left ventricular ejection fraction. Combining both RV and LV dysfunction further elevates this risk, offering new insights for risk stratification.
Area of Science:
- Cardiology
- Echocardiography
- Sudden Cardiac Death Research
Background:
- Left ventricular ejection fraction (LVEF) <35% is a less effective predictor of sudden cardiac death (SCD).
- Novel markers are needed for improved SCD risk stratification.
- Right ventricular (RV) abnormalities are linked to SCD in conditions like COPD and sleep apnea.
Purpose of the Study:
- To determine if RV abnormalities are associated with SCD.
- To assess RV abnormalities independently of LVEF and other patient factors.
Main Methods:
- A prospective, community-based study of SCD cases and controls.
- Analysis of digital echocardiograms to assess RV basal diameter, RV end-diastolic area, and RV fractional area change (RVFAC).
- Multivariate analysis to evaluate associations with SCD.
Main Results:
- RV fractional area change (RVFAC) was significantly associated with SCD (OR 1.14 per 5% decrease, P=.01).
- RV dysfunction (RVFAC ≤35%) combined with low LVEF (≤35%) significantly increased SCD risk.
- Individuals with both left and right ventricular dysfunction had 3x higher odds of SCD (OR 3.19, P=.01).
Conclusions:
- RV dysfunction is an independent predictor of SCD, even when LVEF is normal.
- Combined RV and left ventricular dysfunction have additive effects on SCD risk.
- RV abnormalities represent a crucial, underutilized marker for SCD risk stratification.
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