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67 Obesity and Sudden Death. Pathological Insights from a Large Pathology Registry
  1. Gherardo Finocchiaro1,
  2. Michael Papadakis2,
  3. Harshil Dhutia2,
  4. Ahmed Merghani1,
  5. Stathis Papatheodorou1,
  6. Elijah Behr2,
  7. Sanjay Sharma2,
  8. Mary Sheppard1
  1. 1St George’s University of London Hospital
  2. 2St George’s University Hospital

Abstract

Aims Obesity is a rising public health problem and widely known risk factor for cardiovascular diseases. The relationship between obesity and sudden cardiac death (SCD) is unclear and based on small cohort studies. The aim of the study was to determine the main features and aetiologies in a large cohort of SCD occurred in obese subjects

Methods Between 1994 and 2014, 3684 consecutive cases of SCD were referred to our cardiac pathology centre. In 1954 body mass index (BMI) data were available; obesity was defined by a BMI ≥ 30. All subjects underwent macroscopic and microscopic post-mortem evaluation by an expert cardiac pathologist. Clinical information were obtained from the referring coroners.

Results Four hundred ninety-one patients (25%) were obese. The average heart weight (HW) in obese patients was 505 ± 170 g and 186 (38%) had a HW of more than 500 g. Obese patients were older at death (39 ± 14 vs 35 ± 16 years in non-obese, p < 0.001). In obese SCD victims the most common post-mortem findings were: normal heart (sudden arrhythmic death syndrome, SADS) (n = 192, 39%), followed by idiopathic left ventricular hypertrophy (ILVH) (n = 88, 18%) and critical coronary artery disease (CAD) (n = 57, 12%). Less frequently observed were hypertrophic cardiomyopathy (HCM) (n = 24, 4%) and arrhythmogenic right ventricular cardiomyopathy (ARVC) (n = 22, 4%). When compared with non-obese SCD victims, SADS was less common (39 vs 51%, p < 0.001) while ILVH and critical CAD were more frequent (18 vs 3%, p < 0.001 and 12 vs 6%, p < 0.001 respectively). In young patients (<35 years old) the prevalence of critical and non-critical CAD was significantly higher in obese subjects (23 vs 10% in non-obese, p < 0.001).

Conclusions Various conditionsunderlie SCD inobese patients, with a prevalence of SADS, ILVH and CAD. The degree of hypertrophy measured by heart weight appears in excess even after correction for body size, postulating its possible pathogenetic role in the development of fatal arrhythmias. Almost one in four young obese sudden death victims shows some degree of CAD, underscoring the need for primary prevention in this particular subgroup.

  • Sudden death
  • Obesity
  • Left ventricular hypertrophy

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