Left ventricular hypertrophy and sudden cardiac death

Area of Science:

• Cardiology
• Pathophysiology
• Public Health

Background:

• Sudden cardiac death (SCD) is a major cause of mortality globally, particularly affecting younger populations.
• Current risk stratification for primary prevention relies heavily on left ventricular ejection fraction (LVEF), often leading to under-treatment.
• A significant proportion of SCD events occur in individuals with LVEF > 35%, highlighting limitations in current predictive models.

Purpose of the Study:

• To investigate the role of left ventricular hypertrophy (LVH) as an independent risk factor for SCD.
• To explore the association between LV geometry and SCD risk, irrespective of LVEF.
• To emphasize the need for incorporating LV geometry into SCD risk stratification strategies.

Main Methods:

• Review of physiological and pathophysiological mechanisms of LVH.
• Analysis of epidemiological data linking LVH and SCD.
• Discussion of potential mechanisms connecting LVH to SCD.

Main Results:

• LVH is a potent independent risk factor for SCD across various etiologies and symptom severities.
• Concentric and eccentric LVH, as well as concentric remodeling, are associated with increased SCD risk.
• Current LVEF-based stratification misses a substantial number of SCD cases.

Conclusions:

• LVH plays a critical role in SCD pathogenesis.
• Evaluating LV geometry, in addition to LVEF, is crucial for improving SCD risk prediction.
• Incorporating LV geometry assessment into clinical practice can enhance primary prevention strategies for SCD.