Abstract 14696: Significant Association of Valvular Heart Disease with Sudden Cardiac Death Independent of the LV Ejection Fraction
Background: Aortic and mitral valve conditions are known determinants of overall cardiac mortality but a potential association with sudden cardiac death (SCD) has not been evaluated. We hypothesized that moderate-severe aortic and mitral valve abnormalities are determinants of SCD in the community.
Methods: SCD cases and controls ≥18 yrs were identified from an ongoing prospective evaluation of SCD in the northwest US (approximately 1 million population, 2002 - 2012). Analysis was limited to cases and controls with echocardiogram available; for cases the echocardiogram was prior to and unrelated to the arrest. Univariate comparisons of cases and controls (including severity of mitral and aortic valvular abnormalities) were evaluated using Pearson’s chi-square tests and independent samples t-tests. Logistic regression was used to evaluate the effect of valvular disease on SCD, adjusting for age, race, and LV ejection fraction (EF).
Results: Heart valve information was available for 522 cases and 388 controls. Controls were younger than cases (67.9±12.1 vs. 70.1±13.7, p=0.01) and more likely to be white, non-Hispanic (90.4 vs. 83.4%, p=0.003). Preserved LVEF was significantly more common in controls (54.6 vs. 40.7%) and cases had higher prevalence of moderate (31.3 vs. 28.2%) or severe LV dysfunction (28.1 vs. 17.2%, p<0.0001). Overall, cases had worse mitral or aortic valve diseases (24.6 vs. 9.5%, p<0.0001) and specifically, more severe mitral regurgitation (MR) (15.6 vs. 4.6%, p<0.0001) and aortic stenosis (AS) (8.6 vs. 3.6%, p=0.002). Adjusting for age, race and EF, moderate to severe MR [OR 3.02 (95% CI, 1.70 - 5.37)] and moderate to severe AS [OR 2.71 (95% CI, 1.41 - 5.21)] each conferred a three-fold risk of SCD.
Conclusions: Moderate to severe valvular disease, especially MR and AS, are independent determinants of SCD in the community. These findings have implications for extending SCD risk stratification methodology beyond the LV ejection fraction.
- © 2012 by American Heart Association, Inc.