Sudden unexpected death and left ventricular mass: A necropsy analysis

216A

ABSTRACTS

JACC Vol. 15, No. 2 February 19903216A

.

SUDDEN UNEXPECTEDDEATH AND LEFT NBCROPSY ANALYSIS.

VENTRXCULAR

MASS:

A

M.D., Cheryl A. Aylesworth, George Katsas, t4.D., B.S., Jeffrey M. Ifiner, Bernard 0. Kosowsky, M.D., F.A.C.C., Tufta University School of Medicine, St. F.A.C.C. M.D., Elitabeth’s Hospital, BostOnr MA. I

Clinical studies have suggested that increased left ventricular amas (LW4) is a risk factor for sudden have depended unexpected death (SUD). These studies principally upon E(X5 identification of increased LVM. this thesis has not been Surprisingly, however, previously tested by controlled necropsy (N) analysis.

fraction (LVEF). and seamental wall motion (SWMI. Age(yrs)

Peak Hqhpnr) RPP(xl0 1 Abnormal TI-201

LV scar

.I I

25f6 Scan

2Bf6 29% 0

LV ischemia

:,

I

lll$42 LVEF(%) Non-cardi!c;

CAD present

Non-cardiac;

C&Dabsent

171f7g 157f4g S/46 (1191 12122 (54%) 206fl4g This controlled N ~alysis thus suggests: 1) LVMantong SUD victims typically exceeds LVM in non-cardiac-death pts; 2) in large proportion of SUD victims, however, LVl4 does not exceed normal limits; and 3) LVM in SUD does not exceed LVl4 in non-sudden death due to CAD. W-22) (n-46)

LVEFcO.55

silent ischemia. but not age or disease duration. The development of nephropathy in IDDM pa may signi@ a need for more intense cardiac evaluation.

Universityof Mnnesota,

Lambert VlD PhD F.A.C.C., University of Fla, Gainesville, Fla

was performedin 8 closed-chestanesthetizeddo&. Cardiac ourput determined by thermodilution techniaue. tend was wied

The cost of right heart catheterization (RHC) and its contribution to management were prospectively evaluated in 200 (75% men) pts undergoing coronary angiography for evaluation of known or suspected coronary artery disease (CAD). Prior to catheterization, data from RHC was not felt to be necessary for management. RESULTS: (All values reported are mean f standard deviation). Mean right heart pressures and cardiac output were all in the normal range, 51 of the pts (25.5%) had insignificant or no CAD, and the ejection fraction was 57.5 f 13.3. Operator time to perfon the extra catheterization and measurements was 5.9 f 2.4 mins. Extra fluoroscopy time was 85.9 f 63.2 sets. Sixty-nine pts (35%) had abnormalities detected as a result of RHC but only 6 pts (3%) had abnormalities discovered that either altered management (in 3) or prompted further evaluation (in 3). Extra cost for RHC (determined by a survey of 4 laboratories for similar procedures) was $775/pt or $5l,667/pt whose management was altered. CQNCLUSION: In pts who are undergoing coronary angiography for CAD where RHC was not felt to clinically necessary, routine RHC is expensive and unlikely to provide major additional information for management.