Temporal trends of left ventricular function preceding sudden cardiac death
Harri Silvola1, Lauri Holmström1, Lasse Pakanen2
1Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland.
Heart Rhythm
|August 13, 2026
Summary
The proportion of sudden cardiac death (SCD) victims with severely reduced left ventricular ejection fraction (LVEF) has significantly decreased over two decades. This suggests LVEF alone is insufficient for modern SCD risk assessment.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Severely reduced left ventricular ejection fraction (LVEF ≤35%) is a primary indicator for therapies preventing sudden cardiac death (SCD).
- The changing spectrum of LVEF in contemporary SCD cases requires investigation.
Purpose of the Study:
- To analyze temporal trends in LVEF among SCD victims over a 20-year period.
- To compare LVEF in SCD cases with both ischemic and non-ischemic etiologies.
Main Methods:
- Population-based study of 5,869 autopsy-verified SCD cases in Northern Finland (1998-2017).
- LVEF data obtained from electronic health records, independent of the SCD event.
- Analysis of temporal trends using 5-year study period quartiles.
Main Results:
- Pre-SCD LVEF data available for 716 victims.
- Prevalence of severely reduced LVEF (≤35%) decreased significantly from 30.6% (1998-2002) to 10.6% (2013-2017).
- SCD incidence remained stable, indicating a declining proportion of high-risk LVEF individuals among SCD cases.
Conclusions:
- The proportion of SCD cases with LVEF ≤35% has markedly decreased in recent decades.
- Current LVEF criteria identify a minority of modern SCD victims as high-risk.
- Individualized risk stratification beyond LVEF is crucial for predicting SCD.
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