Sudden cardiac death due to aortic stenosis

Characteristics of subjects with sudden cardiac death (SCD) due to aortic stenosis (AS) are not well defined. Aim of this study was to present clinical and autopsy findings of SCD subjects in whom AS was determined to be the cause of death.

Study population was based on the Finnish Genetic Study of Arrhythmic Events (Fingesture), a large registry which included 5869 consecutive subjects of autopsy-verified SCD between 1998 and 2017. The cause of death was determined based on medicolegal investigation combining data from medical records, police reports and autopsy. Clinical history, ECGs and echocardiographic data were reviewed when available.

Valvular heart disease (VHD) was determined to be the cause of SCD in 64 subjects (1.1%), where AS was the most frequent cause of SCD due to VHD (68.8%). The average age in victims of SCD due to AS was 67.5±12.1 years and 79.5% were male. Documented angina or dyspnoea prior to SCD due to AS was rare (6.8% and 4.5%, respectively), and over half of the SCD subjects (54.5%) did not have a previously established diagnosis of AS. Almost all subjects (93.2%) with SCD due to AS had cardiac hypertrophy and myocardial fibrosis at autopsy.

VHD is a rare cause of SCD, where AS is the dominant underlying pathology. SCD due to AS occurs often without previous diagnosis. Near-universal presence of cardiac hypertrophy and myocardial fibrosis at autopsy supports the role of advanced myocardial disease in the pathogenesis of SCD due to AS.