Author + information
- Zian H. Tseng,
- Philip Ursell,
- Benjamin Colburn,
- Lauren McGuire,
- Eric Vittinghoff,
- Jeffrey Olgin,
- Amy Hart and
- Ellen Moffatt
Interstitial myocardial fibrosis is increasingly recognized as a substrate for arrhythmias and sudden cardiac death (SCD), but has also been described in CHF, HTN, and normal aging. Noninvasive assessment has been performed previously but direct evaluation by systematic sampling at autopsy of arrhythmic sudden deaths (SDs) compared to controls has not been performed. We hypothesized that interstitial fibrosis is associated with arrhythmic SD.
In the first 8 months of the Comprehensive UCSF SCD Study (02/2011-11/2011), results from systematic autopsy performed on 197 of 204 (96.6%) of all incident WHO SCDs citywide and 41 randomly selected accidental trauma deaths (controls) were compared. Arrhythmic SDs required documented VT/VF and/or absence of fatal non-cardiac (eg, PE, lethal toxicology) or non-arrhythmic (eg, tamponade) autopsy findings. Full thickness trichrome-stained sections were analyzed under 40X microscopy for the first 23 arrhythmic SDs, 12 nonarrhythmic SDs, and 13 controls, from: ventricular septum, anterior, lateral, and inferior LV free walls, and anterior RV. Each section was adjudicated by two pathologists blinded to case-control status as none (0), mild (1), moderate (2), or severe (3) fibrosis. For each heart, the composite score was the sum of scores for each of the 5 sampled areas (maximum 15).
Composite interstitial fibrosis score was 1.7-fold higher in arrhythmic SD hearts vs. control hearts, mean 8.5 vs. 4.9 (std dev 3.4; p=0.04) and 1.3-fold higher in nonarrhythmic SD hearts vs. control hearts, mean 6.6 vs. 4.9 (std dev 4.0; p=0.04). Composite score was 1.3-fold higher in arrhythmic SD hearts vs. control hearts, adjusted for age, sex, and race (95% CI 1.01-1.68, p=0.05), but comparable in nonarrhythmic SD hearts vs. control hearts (p=0.4).
Interstitial fibrosis was 30% higher in arrhythmic SDs compared to controls, therefore increased interstitial fibrosis above the background degree related to aging and prevalent heart disease may lead to arrhythmic SD risk. If confirmed in further study, interstitial fibrosis may be a useful surrogate for quantification of SD risk in vulnerable persons.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias: Sudden Cardiac Death – Mechanisms and Treatment Strategies
Abstract Category: 6. Arrhythmias: Other
Presentation Number: 1192-53
- 2013 American College of Cardiology Foundation