Left ventricular hypertrophy is associated with the risk of sudden cardiac death

Abstract

Aims: The echocardiographic identification of risk markers may enhance risk stratification for the development of sudden cardiac death (SCD). However, the value of left ventricular (LV) hypertrophy in the prediction for the risk for SCD is not well known. Methods and results: Echocardiography with the assessment of LV mass was defined in a representative population-based sample of 906 men (age 42-61 years). During an average follow-up period of 20.2 years (interquartile range 18.8-21.3 years), 66 SCDs occurred. The hazard ratio (HR) for SCD was 1.10 (95% confidence interval, CI 1.06-1.15, p<0.001) for each 10 g increment in LV mass, after adjustment for age, alcohol consumption, cigarette smoking, serum low and high density lipoprotein cholesterol, systolic blood pressure, type 2 diabetes, body mass index, high sensitivity C-reactive protein, previous myocardial infarction and cardiorespiratory fitness. Men with elevated LV mass of over 253 grams (highest quartile) had a 3.24-fold (95% CI 1.52 to 6.91, p=0.002) adjusted HR for an SCD as compared to those with LV mass of less than 186 grams (lowest quartile). After additional adjustment for LV function, the relation between LV mass and SCD remained statistically significant in the highest quartile of LV mass (HR 2.72, 95% CI 1.25 to 5.96, p=0.012). The risk for SCD was increased in 175 men with an indexed LV mass of over 125 g/m2 (3.25-fold, 95% CI 1.94 to 5.43, p<0.001). The integrated discrimination index was 0.094 (p=0.0002) indicating the significant level of discrimination improvement with LV mass. Conclusion: LV mass provides an incremental predictive value for SCD beyond that of other well-known risk factors. This study provides evidence that LV hypertrophy improves risk stratification for SCD in the general male population.