Abstract 14216: Sudden Arrhythmic Death Is Associated With Lower Global Longitudinal Strain and Longer Mechanical Dispersionin the San Francisco Postmortem Systematic Investigation of Sudden Cardiac Death (POST SCD) Study

• Published in: Circulation (New York, N.Y.) N.Y.), 2019-11, Vol.140 (Suppl_1 Suppl 1), p.A14216-A14216
• Main Authors: Ramakrishna, Satvik, Bibby, Dwight, Vittinghoff, Eric, Bedigian, Annie, Probert, Joanne, Lim, Lisa, Olgin, Jeffrey, Ursell, Philip, Moffatt, Ellen, Tseng, Zian H, Delling, Francesca N
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.140.suppl_1.14216

IntroductionGlobal longitudinal strain (GLS) and mechanical dispersion (MD) by speckle-tracking echocardiography can predict sudden cardiac death (SCD) beyond left ventricular ejection fraction (LVEF) alone. However, prior studies have presumed cardiac cause from EMS records or death certificates rather than gold-standard autopsies. We sought to compare GLS and MD in autopsy-defined sudden arrhythmic death (SAD) vs. non-SAD in a comprehensive postmortem study of all presumed SCDs in San Francisco (SF) County.MethodsFrom 2/2011 - 3/2014, all incident World Health Organization-defined (presumed) SCDs ages 18-90 were identified for autopsy via active surveillance of all out of hospital deaths in the SF POstmortem Systematic Investigation of Sudden Cardiac Death (POST SCD) Study. Autopsy-defined SADs had no extra-cardiac cause of death or acute HF. For subjects with available pre-mortem echocardiograms, we assessed LVEF, LV mass index (LVMI), GLS, and MD. GLS was defined as the average peak longitudinal strain from an 18-segment LV model and MD as the standard deviation of time to peak strain of each segment.ResultsWe autopsied 525 of 541 (97%) incident presumed SCDs in SF over 37 months (mean age 63 years, 69% male); 66/525 (12.6%) had pre-mortem echocardiograms. Of these, 37 (56%) were SADs and 29 (44%) were non-SADs. SAD and non-SADs had similar age, race, cardiovascular risk factors, LVEF, and LVMI (all p >0.05). SADs were predominantly men (81% vs. 52% in non-SADs, p=0.01). GLS was reduced in SADs vs. non-SADs (-12.9 ± 6.3 vs. -16.9 ± 5.7, p=0.01) and MD was increased (14.3 ± 5.8 vs. 11.2 ± 6.1 s, p=0.04) (FigureExample of a SAD case with greater heterogeneity of the time to peak strain for each LV segment, or greater MD, compared to a non-SAD case).ConclusionsIn this systematic county-wide postmortem study of all incident presumed SCDs, autopsy-defined SAD was associated with lower GLS and greater MD. Measurement of GLS and MD may improve risk prediction for true SAD.