Abstract 15866: Relative Wall Thickness in Shockable vs. Non-shockable Sudden Cardiac Arrest in the Community
Introduction: Shockable initial rhythms (VT/VF) during sudden cardiac arrest (SCA) are associated with considerably better resuscitation outcomes than non-shockable rhythms (pulseless electrical activity [PEA] or asystole), but factors associated with these arrhythmias are poorly understood. By analyzing archived echocardiogram reports, we examined the potential role of relative wall thickness (RWT) as a determinant for shockable vs. non-shockable SCA.
Methods: All SCA victims in a Northwest US metro region (population 1 million) were prospectively identified 2002 - 2015, and their medical records reviewed. 385 subjects with an echocardiogram performed prior to SCA, and with documented initial SCA rhythm available were included in the analysis. Association of RWT (2xPWd/LVEDD) and LV ejection fraction (EF) with initial rhythm was studied.
Results: Initial rhythm was VT/VF in 178 (46%) and non-shockable (PEA/asystole) in 207 (54%) subjects. Subjects with VT/VF were younger (65.6±13.5 vs 68.6±13.4yrs, p=0.032) and more likely male (77.5% vs 59.9%, p<0.001). Coronary artery disease was more common (74.2% vs 63.8%, p=0.029) and EF lower (44.4±16.5 vs 50.6±15.8%, p<0.001) among subjects with VT/VF. Each 0.01-unit decrease in RWT was associated with 4.5% increase in the likelihood of VT/VF as the initial rhythm (p<0.001). Figure demonstrates increasing unadjusted odds ratios (OR) for VT/VF associated with decrease in RWT. After adjusting for clinical/demographic variables, EF and arrest characteristics including response time, SCA victims in the lowest RWT quartile (RWT <0.38) were over 3-times more likely to present with VT/VF than non-shockable rhythm (OR 3.3; 95% CI 1.5 - 7.1; p=0.003) compared with the highest RWT quartile (RWT >0.56).
Conclusions: In the community, decreased RWT was strongly associated with VT/VF as the initial rhythm in SCA. These findings have mechanistic and clinical implications for improving resuscitation outcomes from SCA.
Author Disclosures: A.L. Aro: None. C. Teodorescu: None. A. Uy-Evanado: None. K. Reinier: None. D. Phan: None. K. Gunson: None. J. Jui: None. S.S. Chugh: Research Grant; Significant; NIH (NHLBI), R01HL126938 and R01HL122492.
- © 2016 by American Heart Association, Inc.