Left Ventricular Hypertrophy Is a Common Cause of Sudden Unexpected Death in African-Americans
N Cresswell, Y Zhang, D Fowler, R Kutys, A Burke, L Li. Armed Forces Institute of Pathology, Washington, DC; CVPath Institute, Inc, Gaithersburg, MD; University of Maryland, Baltimore, MD
Background: The effect of race on the frequency of arrhythmogenic substrates in hypertensive atherosclerotic cardiovascular disease (HASCVD) has not been extensively studied.
Design: All hearts from adult sudden deaths in 2007 were studied if the cause of death after forensic autopsy was cardiac, included features of HASCVD, and excluded specific cardiomyopathy, myocarditis or valve disease. Myocardial scarring was described grossly; cardiomegaly defined by heart weight, body weight and height, and ventricular wall thickness; and severe coronary disease defined as >75% luminal narrowing of at least one epicardial artery. Coronary disease was considered the single mechanism of death if there was an acute thrombus or severe disease in the absence of scars and cardiomegaly.
Results: 406 cases comprising 157 blacks, 249 whites, 119 women, and 287 men were examined. Mean age was 4913 years in whites and 4713 in blacks (p=0.2). Coronary atherosclerosis was the single mechanism of death in 27% of whites and 22% of blacks, with acute thrombi present in 48% and 36%, respectively (p=.08). Severe atherosclerosis was present in 58% of whites and 45% of blacks (p=.1), but extent of disease was less in blacks (p=.004). Cardiomegaly was the single mechanism of death in 38% of whites and 50% of blacks (p=.01); a history of hypertension was known in 48% (40% of whites and 57% of blacks). Cardiomegaly was present in 73% of both blacks and whites. Old scar was the primary cause of death in <3% and was present with other substrates in 18% of whites and 11% of blacks. Multiple substrates were present in 32% of whites and 24% of blacks. A history of alcoholism was more frequent in isolated cardiomegaly than coronary disease (11% vs. 1%, p=.001). Deaths were exertional in 2% of isolated cardiomegaly deaths vs. 5% of isolated atherosclerosis (p=0.3). By multivariate analysis, black race (p=.01) was inversely related to extent of coronary disease, independent of age, gender, and risk factors, and positively related to isolated cardiomegaly as a cause of death (p=0.04).
Conclusions: In sudden cardiac death due to HASCVD extent of coronary disease is less in blacks and isolated cardiomegaly more frequent in whites. Cardiomegaly is as important a cause of sudden cardiac death in African-Americans as coronary atherosclerosis.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 1, Wednesday Afternoon