Sudden Cardiac Death in CKD and ESKD: Risk Factors, Mechanisms, and Therapeutic Strategies

Sudden cardiac death (SCD) still represents an unanticipated and catastrophic event eliciting from cardiac causes. SCD is the leading cause of non-traumatic deaths during downhill skiing and mountain hiking, related to the fact that these sports are very popular among elderly people. Annually, more than 40 million downhill skiers and mountain hikers/climbers visit mountainous regions of the Alps, including an increasing number of individuals with pre-existing chronic diseases. Data sets from two previously published case-control studies have been used to draw comparisons between the SCD risk of skiers and hikers. Data of interest included demographic variables, cardiovascular risk factors, medical history, physical activity, and additional symptoms and circumstances of sudden death for cases. To establish a potential connection between the SCD risk and sport-specific physical strain, data on cardiorespiratory responses to downhill skiing and mountain hiking, assessed in middle-aged men and women, have been included. It was demonstrated that previous myocardial infarction (MI) (odds ratio; 95% CI: 92.8; 22.8–379.1; p < 0.001) and systemic hypertension (9.0; 4.0–20.6; p < 0.001) were predominant risk factors for SCD in skiers, but previous MI (10.9; 3.8–30.9; p < 0.001) and metabolic disorders like hypercholesterolemia (3.4; 2.2–5.2; p < 0.001) and diabetes (7.4; 1.6–34.3; p < 0.001) in hikers. More weekly high-intensity exercise was protective in skiers (0.17; 0.04–0.74; p = 0.02), while larger amounts of mountain sports activities per year were protective in hikers (0.23; 0.1–0.4; <0.001). In conclusion, previous MI history represents the most important risk factor for SCD in recreational skiers and hikers as well, and adaptation to high-intensity exercise is especially important to prevent SCD in skiers. Moreover, the presented differences in risk factor patterns for SCDs and discussed requirements for physical fitness in skiers and hikers will help physicians to provide specifically targeted advice.

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Vital exhaustion and sudden cardiac death in the Atherosclerosis Risk in Communities Study

Heart ◽

10.1136/heartjnl-2017-311825 ◽

2017 ◽

Vol 104 (5) ◽

pp. 423-429 ◽

Cited By ~ 2

Author(s):

Brittany M Bogle ◽

Nona Sotoodehnia ◽

Anna M Kucharska-Newton ◽

Wayne D Rosamond

Keyword(s):

Risk Factors ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Disease Risk ◽

Ventricular Tachyarrhythmia ◽

Atherosclerosis Risk In Communities ◽

Vital Exhaustion ◽

Increased Risk ◽

Atherosclerosis Risk ◽

Aric Study

ObjectiveVital exhaustion (VE), a construct defined as lack of energy, increased fatigue and irritability, and feelings of demoralisation, has been associated with cardiovascular events. We sought to examine the relation between VE and sudden cardiac death (SCD) in the Atherosclerosis Risk in Communities (ARIC) Study.MethodsThe ARIC Study is a predominately biracial cohort of men and women, aged 45–64 at baseline, initiated in 1987 through random sampling in four US communities. VE was measured using the Maastricht questionnaire between 1990 and 1992 among 13 923 individuals. Cox proportional hazards models were used to examine the hazard of out-of-hospital SCD across tertiles of VE scores.ResultsThrough 2012, 457 SCD cases, defined as a sudden pulseless condition presumed due to a ventricular tachyarrhythmia in a previously stable individual, were identified in ARIC by physician record review. Adjusting for age, sex and race/centre, participants in the highest VE tertile had an increased risk of SCD (HR 1.48, 95% CI 1.17 to 1.87), but these findings did not remain significant after adjustment for established cardiovascular disease risk factors (HR 0.94, 95% CI 0.73 to 1.20).ConclusionsAmong participants of the ARIC study, VE was not associated with an increased risk for SCD after adjustment for cardiovascular risk factors.

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Prevention of atrial fibrillation – non-modifiable and modifiable risk factors for AF

In a good rythm ◽

10.5604/01.3001.0014.2845 ◽

2020 ◽

Vol 2 (55) ◽

pp. 14-19

Author(s):

Agnieszka Wojdyła-Hordyńska ◽

Grzegorz Hordyński

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Cardiovascular Diseases ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Combined Treatment ◽

Lifestyle Changes ◽

Modifiable Risk Factors

Atrial fibrillation is one of the most common arrhythmias, with a significant increase in incidence in recent years. AF is a major cause of stroke, heart failure, sudden cardiac death, and cardiovascular disease. Timely intervention and modification of risk factors increase chance to stop the disease. Aggressive, multilevel prevention tactics are a component of combined treatment, including – in addition to lifestyle changes, anticoagulant therapy, pharmacotherapy and invasive anti-arrhythmic treatment – prevention of cardiovascular diseases, hypertension, ischemia, valvular disease and heart failure.

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Abstract 14760: Myocardial Scarring by Magnetic Resonance Predicts Sudden Cardiac Death in Pediatric Patients With Hypertrophic Cardiomyopathy

Circulation ◽

10.1161/circ.142.suppl_3.14760 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Lars Grosse-Wortmann ◽

Laurine van der Wal ◽

Aswathy Vaikom House ◽

Lee Benson ◽

Raymond Chan

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Hypertrophic Cardiomyopathy ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Pediatric Patients ◽

Risk Markers ◽

C Statistic ◽

Increased Risk ◽

Traditional Risk Factors

Introduction: Cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) has been shown to be an independent predictor of sudden cardiac death (SCD) in adults with hypertrophic cardiomyopathy (HCM). The clinical significance of LGE in pediatric HCM patients is unknown. Hypothesis: LGE improves the SCD risk prediction in children with HCM. Methods: We retrospectively analyzed the CMR images and reviewed the outcomes pediatric HCM patients. Results: Amongst the 720 patients from 30 centers, 73% were male, with a mean age of 14.2±4.8 years. During a mean follow up of 2.6±2.7 years (range 0-14.8 years), 34 experienced an episode of SCD or equivalent. LGE (Figure 1A) was present in 34%, with a mean burden of 14±21g, or 2.5±8.2g/m2 (6.2±7.7% of LV myocardium). The presence of ≥1 adult traditional risk factor (family history of SCD, syncope, LV thickness >30mm, non-sustained ventricular tachycardia on Holter) was associated with an increased risk of SCD (HR=4.6, p<0.0001). The HCM Risk-Kids score predicted SCD (p=0.002). The presence of LGE was strongly associated with an increased risk (HR=3.8, p=0.0003), even after adjusting for traditional risk factors (HR adj =3.2, p=0.003) or the HCM Risk-Kids score (HR adj =3.5, p=0.003). Furthermore, the burden of LGE was associated with increased risk (HR=2.1/10% LGE, p<0.0001). LGE burden remained independently associated with an increased risk for SCD after adjusting for traditional risk factors (HRadj=1.5/10% LGE, p=0.04) or HCM Risk-Kids (HRadj=1.9/10% LGE, p=0.0018, Figure 1B). The addition of LGE burden improved the predictive model using traditional risk markers (C statistic 0.67 vs 0.77, p=0.003) and HCM Risk-Kids (C statistic 0.68 vs 0.74, p=0.045). Conclusions: Quantitative LGE is an independent risk factor for SCD in pediatric patients with HCM and improves the performance of traditional risk markers and the HCM Risk-Kids Score for SCD risk stratification in this population.

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Exercise heart rate reserve and recovery as risk factors for sudden cardiac death

Progress in Cardiovascular Diseases ◽

10.1016/j.pcad.2021.09.002 ◽

2021 ◽

Author(s):

Sudhir Kurl ◽

Sae Young Jae ◽

Ari Voutilainen ◽

Magnus Hagnäs ◽

Jari A. Laukkanen

Keyword(s):

Risk Factors ◽

Heart Rate ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Exercise Heart Rate ◽

Heart Rate Reserve

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Heart rate and metabolic response to competitive squash in veteran players: identification of risk factors for sudden cardiac death

European Heart Journal ◽

10.1093/oxfordjournals.eurheartj.a059415 ◽

1989 ◽

Vol 10 (11) ◽

pp. 1029-1035 ◽

Cited By ~ 5

Author(s):

H. R. BRADY ◽

M. KINIRONS ◽

T. LYNCH ◽

E. M. OHMAN ◽

W. TORMEY ◽

...

Keyword(s):

Risk Factors ◽

Heart Rate ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Metabolic Response

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Limited Evidence for Risk Factors for Proarrhythmia and Sudden Cardiac Death in Patients Using Antidepressants: Dutch Consensus on ECG Monitoring

Drug Safety ◽

10.1007/s40264-018-0649-z ◽

2018 ◽

Vol 41 (7) ◽

pp. 655-664 ◽

Cited By ~ 3

Author(s):

Mirjam Simoons ◽

Adrie Seldenrijk ◽

Hans Mulder ◽

Tom Birkenhäger ◽

Mascha Groothedde-Kuyvenhoven ◽

...

Keyword(s):

Risk Factors ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Ecg Monitoring ◽

Limited Evidence

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Abstract P029: Racial Differences in Sudden Cardiac Death: Findings From the Atherosclerosis Risk in Communities Study (ARIC)

Circulation ◽

10.1161/circ.137.suppl_1.p029 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Di Zhao ◽

Eliseo Guallar ◽

Elena Blasco-Colmenares ◽

Nona Sotoodehnia ◽

Wendy Post

Keyword(s):

Risk Factors ◽

African Americans ◽

Sudden Cardiac Death ◽

Racial Differences ◽

Cardiac Death ◽

Large Scale ◽

Community Dwelling ◽

Mediation Effect ◽

P Value ◽

Expert Committee

Background: In hospital-based studies and in studies of participants with pre-existing conditions, African Americans have a higher risk of in- and out-of-hospital sudden cardiac death (SCD) compared with Whites. However, the risk of SCD of African Americans and Whites has never been compared in large-scale community-based cohort studies. Objective: To compare the risk of SCD among African Americans and Whites, and to evaluate the risk factors that may explain racial differences in incidence. Methods: Cohort study of 3,838 African Americans and 11,245 Whites participating in ARIC. Race was self-reported. SCD cases were defined as a sudden pulseless condition from a cardiac cause in a previously stable individual and adjudicated by an expert committee. Mediation effect of covariates was calculated using boot-strapping method. Cox proportional hazards models were adjusted for demographics, social economic status, cardiovascular (CVD), and electrocardiographic risk factors. Results: The mean (SD) age was 53.6 (5.8) for African Americans and 54.4 (5.7) years for Whites. During 25.3 years of follow-up, 215 African Americans and 332 Whites experienced SCD. In multivariable-adjusted models, the HRs (95% CI) for SCD comparing African Americans and Whites were 1.70 (1.37, 2.10) overall, 2.00 (1.40, 2.84) in women, and 1.46 (1.10, 1.92) in men (p-value for race by sex interaction 0.02; Table ). CVD and electrocardiographic risk factors explained 36.6% (21.4, 51.8%) of the excess risk of SCD in African Americans, with a large proportion of racial differences unexplained. Conclusions: The risk of SCD in community-dwelling African Americans was significantly higher than in Whites, particularly among women. CVD risk factors, including higher prevalence of obesity, diabetes, hypertension and LV hypertrophy in African Americans, explained only a small fraction of this difference. Further research is needed to identify factors responsible for race differences in SCD and to implement prevention strategies in high-risk minorities.

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Abstract 5017: An Insertion/Deletion Polyporphism in α 2 -Adrenergic Receptor Gene is a Novel Genetic Risk Factors Sudden Cardiac Death

Circulation ◽

10.1161/circ.118.suppl_18.s_1132-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Jari Laukkanen

Keyword(s):

Risk Factors ◽

Cardiovascular Diseases ◽

Sudden Cardiac Death ◽

Genetic Risk ◽

Cardiac Death ◽

Cox Model ◽

Receptor Gene ◽

Hdl Cholesterol ◽

Population Based ◽

Coronary Risk Factors

α 2B -adrenoceptors mediate contraction of vascular smooth muscle and induce coronary vasoconstriction in humans. A variant of the human α 2B -adrenoceptor gene that encodes a D of three residues in an intracellular acidic motif has been shown to confer decreased receptor desensitization. This receptor variant could, therefore, be involved in cardiovascular diseases associated with enhanced vasoconstriction. Our aim was to study whether an insertion/deletion (I/D) polymorphism in the α 2B -adrenoceptor gene is associated with the risk for sudden cardiac death. This study was part of a prospective population-based study investigating risk factors for cardiovascular diseases in a cohort of middle-aged men from eastern Finland. The study is based on 1606 men 42 to 60 years of age followed for an average time of 17 years. In this study population, 338 men (21%) had the D/D genotype; 467 (29 %) had the I/I genotype, and 801 (50%) had a heterozygous genotype. There were 76 sudden cardiac deaths during follow-up. In a Cox model adjusting for other coronary risk factors (age, systolic blood pressure, smoking, diabetes, serum LDL and HDL cholesterol, body mass index and exercise-induced myocardial ischemia), men with the D/D or I/D genotype had 1.95 time (95% confidence interval, 1.07 to 3.55, P = 0.029) higher risk to experience sudden cardiac death (20 events for D/D genotype, 13 events for I/I genotype and 43 events for I/D genotype) compared with men carrying the I/I genotype. The α 2B -adrenoceptor genotype was associated with coronary heart disease death but not with hypertension. The D/D and I/D genotypes of the α 2B -adrenoceptor are novel genetic risk predictors for sudden cardiac death.

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