In a 12-year postmortem study of 513 arrhythmic sudden cardiac deaths, only 32% had previously diagnosed risk factors, while 31% had occult myocardial infarction or dilated cardiomyopathy.
Observational (n=877)
What is the prevalence of previously diagnosed risk factors and occult cardiac disease among community sudden cardiac deaths?
Two-thirds of community arrhythmic sudden cardiac deaths occur in individuals without previously diagnosed disease, with half of these silent deaths having occult MI or dilated cardiomyopathy, highlighting the need for improved detection.
BACKGROUND Sudden cardiac death (SCD) prevention focuses on individuals with diagnosed disease (ie, conventional SCD risk factors RFs) such as reduced ejection fraction and myocardial infarction (MI). The burden of occult disease among community SCDs without diagnosed RFs is unknown and represents a target for prevention through increased detection. OBJECTIVES This study sought to determine the sensitivity of diagnosed RFs for community sudden deaths and identify cardiac pathology, including occult MI and dilated cardiomyopathy (DCM), among community sudden deaths without diagnosed RFs. METHODS The POST SCD (POstmortem Systematic invesTigation of Sudden Cardiac Death) is a prospective countywide study using autopsy to adjudicate arrhythmic (potentially rescuable with defibrillator) or nonarrhythmic (eg, tamponade, overdose) deaths among presumed SCDs meeting World Health Organization criteria. We assessed prevalence ("sensitivity") of diagnosed RFs (ejection fraction ≤35%, heart failure, prior MI, syncope) among arrhythmic, nonarrhythmic, and reference trauma deaths. Among arrhythmic deaths without diagnosed RFs, we assessed occult cardiac pathologies including DCM (short-axis diameter ≥3.5 cm and heart weight 1 SD more than expected based on sex, age, height, and weight; Z-score =1) and healed MI (histopathological evidence of healed MI). RESULTS Of 877 presumed SCDs, 513 (58%) were autopsy-defined arrhythmic deaths, of which 166 subjects (32%) had diagnosed RFs (mean age: 64.3 years; 77% men); therefore, sensitivity of RFs for arrhythmic death was 32%. Another 159 subjects (31%) had occult MI or DCM with similar demographics (mean age: 62.6 years; 80% men) and cardiac pathologies as those with RFs, including fibrosis and coronary disease. The remaining 185 arrhythmic deaths (36%) were subjects who were younger (mean age: 56.9 years) with less cardiac pathology than arrhythmic deaths with occult MI or DCM but still had increased heart weight (Z-score: 0.9 vs 0.0), larger left ventricular diameter (2.5 cm vs 1.9 cm), and more significant coronary disease (52% vs 13%, all P < 0.001) but similar fibrosis (6.7% vs 6.3%) and left ventricular hypertrophy burden (57% vs 55%) than trauma deaths. CONCLUSIONS In this 12-year countywide postmortem study, two-thirds of community arrhythmic SCDs occurred in individuals without diagnosed disease despite substantial cardiac pathology; half of these "silent" arrhythmic deaths had occult MI or DCM. Improved detection of occult cardiac disease is a critical priority to reduce community sudden deaths.
“The use of modern tools, combining, for example, the integration of physiological signals from connected devices (smartwatches, cell phones) with continuous analysis facilitated by artificial intelligence, could be a promising avenue for detecting hidden heart conditions.”
Salazar et al. (Wed,) conducted a observational in Sudden Cardiac Death (n=877). Postmortem systematic investigation vs. Trauma deaths was evaluated on Sensitivity of diagnosed risk factors for arrhythmic death. In a 12-year postmortem study of 513 arrhythmic sudden cardiac deaths, only 32% had previously diagnosed risk factors, while 31% had occult myocardial infarction or dilated cardiomyopathy.