Relative risk of sudden cardiac death during marathon running

Introduction: Noninvasive identification of patients at risk for sudden cardiac death (SCD) remains a major clinical challenge. Abnormal ventricular repolarization is associated with increased risk of lethal ventricular arrhythmias and SCD. Hypothesis: We investigated the hypothesis that spatial repolarization heterogeneity can identify patients at risk for SCD in general population. Methods: Spatial R-, J- and T-wave heterogeneities (RWH, JWH and TWH, respectively) were automatically analyzed with second central moment technique from standard digital 12-lead ECGs in 5618 adults (46% men; age 50.9±12.5 yrs.) who took part in Health 2000 Study, an epidemiological survey representative of the entire Finnish adult population. During average follow-up of 7.7±1.4 years, a total of 72 SCDs occurred. Thresholds of RWH, JWH and TWH were based on optimal cutoff points from ROC curves. Results: Increased RWH, JWH and TWH (Fig.1) in left precordial leads (V4-V6) were univariately associated with SCD (P<0.001, each). When adjusted with clinical risk markers (age, gender, BMI, systolic blood pressure, cholesterol, heart rate, left ventricular hypertrophy, QRS duration, arterial hypertension, diabetes, coronary heart disease and previous myocardial infarction) JWH and TWH remained as independent predictors of SCD. Increased TWH (≥102μV) was associated with a 1.9-fold adjusted relative risk (95% confidence interval [CI]: 1.2 - 3.1; P=0.011) and increased JWH (≥123μV) with a 2.0-fold adjusted relative risk for SCD (95% CI: 1.2 - 3.3; P=0.004). When both TWH and JWH were above threshold, the adjusted relative risk for SCD was 3.2-fold (95% CI: 1.7 - 6.2; P<0.001). When all heterogeneity measures (RWH, JWH and TWH) were above threshold, the risk for SCD was 3.7-fold (95% CI: 1.6 - 8.6; P=0.003). Conclusions: Automated measurement of spatial J- and T-wave heterogeneity enables analysis of high patient volumes and is able to stratify SCD risk in general population.

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Prior myocardial infarction in the young: predisposes to a high relative risk but low absolute risk of a sudden cardiac death

EP Europace ◽

10.1093/europace/eus190 ◽

2012 ◽

Vol 15 (1) ◽

pp. 48-54 ◽

Cited By ~ 4

Author(s):

Bjarke Risgaard ◽

Jonas Bille Nielsen ◽

Reza Jabbari ◽

Stig Haunsø ◽

Anders Gaarsdal Holst ◽

...

Keyword(s):

Myocardial Infarction ◽

Relative Risk ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Absolute Risk ◽

High Relative Risk ◽

Prior Myocardial Infarction

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Sudden Cardiac Death during Marathon Running: Lessons from Ancient Greece

The American Journal of Medicine ◽

10.1016/j.amjmed.2012.07.029 ◽

2013 ◽

Vol 126 (3) ◽

pp. e21 ◽

Cited By ~ 1

Author(s):

James J. Glazier

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Ancient Greece ◽

Marathon Running

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Survival Benefit of the Implantable Cardioverter-Defibrillator in Patients on the Waiting List for Cardiac Transplantation

Circulation ◽

10.1161/circ.104.suppl_1.i-171 ◽

2001 ◽

Vol 104 (suppl_1) ◽

Author(s):

Sigrid E. Sandner ◽

Georg Wieselthaler ◽

Andreas Zuckermann ◽

Shahrokh Taghavi ◽

Herwig Schmidinger ◽

...

Keyword(s):

Relative Risk ◽

Sudden Cardiac Death ◽

Sudden Death ◽

Cardiac Death ◽

Cardiac Transplantation ◽

Total Mortality ◽

Waiting List ◽

Bridge To Transplantation ◽

Icd Therapy ◽

Cardioverter Defibrillator

Background The implantable cardioverter-defibrillator (ICD) effectively reduces sudden cardiac death in patients with severe LV dysfunction. Effect of ICD therapy on total mortality in patients on the waiting list for cardiac transplantation is still uncertain. Methods and Results We retrospectively analyzed 854 unselected consecutive patients (ICD therapy, n=102; 11.9%) on the waiting list for cardiac transplantation between January 1992 and March 2000. Actuarial 12-month total mortality rate on the waiting list was 24.2%; sudden cardiac death was the predominant mode of death (66.7% of total deaths). Kaplan-Meier analysis revealed improved survival for ICD (total mortality, 13.2%) compared with non-ICD (total mortality, 25.8%) patients (log rank, P =0.03). No event of sudden death occurred in ICD patients, whereas in non-ICD patients, 12-month sudden death rate was 20.1% ( P =0.0001). Nonsudden death rates did not differ between ICD and non-ICD patients ( P =0.16). A Cox proportional hazards model demonstrated that absence of an ICD was a powerful independent predictor of total mortality ( P =0.02; relative risk, 2.22; 95% confidence interval, 1.16 to 4.17) and sudden cardiac death ( P <0.0001; infinite relative risk) on the waiting list. Conclusions ICD therapy, because it prevents sudden cardiac death, significantly improves survival on the waiting list for cardiac transplantation. The present study supports the use of ICDs as a bridge to transplantation in patients who are at risk of sudden cardiac death. Prospective randomized trials are needed to evaluate the potential benefit of prophylactic ICD therapy as a bridge to transplantation in all patients on cardiac transplant waiting lists.

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Risk for sudden cardiac death associated with marathon running

Journal of the American College of Cardiology ◽

10.1016/0735-1097(96)00137-4 ◽

1996 ◽

Vol 28 (2) ◽

pp. 428-431 ◽

Cited By ~ 139

Author(s):

Barry J. Maron ◽

Liviu C. Poliac ◽

William O. Roberts

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Marathon Running

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For the Evaluation of Pacific Island Athletes, an ECG and Echocardiography Are Highly Recommended

Hearts ◽

10.3390/hearts2020021 ◽

2021 ◽

Vol 2 (2) ◽

pp. 270-277

Author(s):

Jean-Claude Chatard

Keyword(s):

Relative Risk ◽

Sudden Cardiac Death ◽

Physical Examination ◽

Cardiac Death ◽

Heart Diseases ◽

Short Review ◽

Pacific Island ◽

Medical Guidelines ◽

Electrocardiogram Ecg ◽

Valve Lesions

Physical exercise increases the relative risk of sudden cardiac death (SCD) in athletes when compared to a non-sporting population. Pre-participation evaluation (PPE) of athletes is thus of major importance. For Pacific Island athletes, medical guidelines recommend an echocardiography to complement a PPE including personal and family history, a physical examination and a resting twelve-lead electrocardiogram (ECG). Indeed, silent rheumatoid heart diseases found in up to 7.6% of adolescents give rise to severe valve lesions, which are the main causes of SCD in Pacific Island athletes. This short review examines the incidence rate of SCD in Pacific Island athletes and indicates how a questionnaire, physical examination, ECG and echocardiography can prevent it.

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Implantable Cardioverter Defibrillator for the Primary Prevention of Sudden Cardiac Death in Patients With Nonischemic Cardiomyopathy

Angiology ◽

10.1177/0003319717710851 ◽

2017 ◽

Vol 69 (4) ◽

pp. 297-302 ◽

Cited By ~ 2

Author(s):

Rafael Cavalcanti ◽

Nael Aboul-Hosn ◽

Gustavo Morales ◽

Ahmed Abdel-Latif

Keyword(s):

Relative Risk ◽

Primary Prevention ◽

Sudden Cardiac Death ◽

Randomized Controlled Trials ◽

Cardiac Death ◽

Controlled Trials ◽

Nonischemic Cardiomyopathy ◽

Cardioverter Defibrillator ◽

Randomized Controlled ◽

All Cause Mortality

Objectives: The benefit of implanting patients with nonischemic cardiomyopathy (NICMP) with an implantable cardioverter defibrillator (ICD) for primary prevention has not been demonstrated in any randomized controlled trial. This also holds true for the most recent study on the subject. This systematic review and meta-analysis aims to examine the effectiveness of primary prevention using an ICD in the NICMP population. Methods: We searched the literature for randomized controlled trials examining the effectiveness of ICD in reducing all-cause mortality in patients with NICMP. The primary outcome of our analysis was all-cause mortality. A fixed-effects model was used for the primary analysis. Results: A total of 5 randomized controlled trials focused on primary prevention of sudden cardiac death for patients with NICMP that met our inclusion and exclusion criteria. They have individually failed to consistently show a benefit for the use of an ICD in this population. However, the cumulative effect of ICD implantation in patients with NICMP demonstrated a 21% relative risk reduction in mortality (Relative risk [RR]: 0.79; confidence interval: 0.66-0.95). Conclusion: There is a decrease in mortality with the use of ICD for primary prevention in patients with NICMP having left ventricular ejection fraction <35%.

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Low Birth Weight Increases the Risk of Sudden Cardiac Death in the Young: A Nationwide Study of 2.2 Million People

Journal of the American Heart Association ◽

10.1161/jaha.120.018314 ◽

2021 ◽

Author(s):

Vilde Waaler Loland ◽

Frederik Nybye Ågesen ◽

Thomas Hadberg Lynge ◽

Anja Pinborg ◽

Reza Jabbari ◽

...

Keyword(s):

Birth Weight ◽

Relative Risk ◽

Sudden Cardiac Death ◽

Gestational Age ◽

Cardiac Death ◽

Large For Gestational Age ◽

Major Health Problem ◽

Arrhythmic Death ◽

Increased Risk ◽

Sudden Arrhythmic Death Syndrome

Background Sudden cardiac death (SCD) constitutes a major health problem worldwide. We investigated whether birth weight (BW), small for gestational age (SGA), and large for gestational age are associated with altered risk of SCD among the young (aged 1–36 years). Methods and Results We included all people born in Denmark from 1973 to 2008 utilizing the Danish Medical Birth Register. All SCDs in Denmark in 2000 to 2009 have previously been identified. We defined 5 BW groups, SGA, and large for gestational age as exposure and SCD as the outcome. We estimated the age‐specific relative risk of SCD with 95% CI. Additionally, we investigated if SGA and large for gestational age are associated with pathological findings at autopsy. The study population for the BW analyses comprised 2 234 501 people with 389 SCD cases, and the SGA and large for gestational age analyses comprised 1 786 281 people with 193 SCD cases. The relative risk for SCD was 6.69 for people with BW between 1500 and 2499 g (95% CI, 2.38–18.80, P <0.001) and 5.89 for people with BW ≥4500 g (95% CI, 1.81–19.12, P =0.003) at age 5 years. BW 2500 to 3400 g was the reference group. Compared with an appropriate gestational age, the relative risk for SGA was 2.85 (95% CI, 1.35–6.00, P =0.006) at age 10 years. For the autopsied cases, the relative risk of sudden arrhythmic death syndrome at age 5 years was 4.19 for SGA (95% CI, 1.08–16.22, P =0.038). Conclusions We found an association between BW and SCD in the young, with an increased risk among SGA infants. In addition, we found an association between SGA and sudden arrhythmic death syndrome.

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