Key result
Aortic stenosis causes ~69% of valvular sudden cardiac deaths, frequently undiagnosed before fatal presentation.
Why the study?
Characteristics of subjects with sudden cardiac death due to aortic stenosis are not well defined.
Observational (n=5,869)
Sudden cardiac death from aortic stenosis frequently occurs in individuals without a prior diagnosis or warning symptoms, often accompanied by advanced myocardial disease at autopsy.
Answers are grounded in this paper and cite their sources.
Aortic stenosis often underlies valvular sudden cardiac death without prior diagnosis; leaves open whether targeted screening improves detection before fibrosis develops.
Background 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. Methods 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. Results 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. Conclusions 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.
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Riihiniemi et al. (2026) conducted an observational in Sudden cardiac death due to aortic stenosis (n=5,869). Aortic stenosis was evaluated on Prevalence and clinical/autopsy characteristics of sudden cardiac death due to aortic stenosis. Aortic stenosis was the underlying cause in 68.8% of valvular sudden cardiac deaths, with 54.5% of these victims having no prior aortic stenosis diagnosis and 93.2% showing myocardial fibrosis.
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