Cardiac pathologic findings reveal a high rate of sudden cardiac death of undetermined etiology in younger women
Cardiac pathologic findings reveal a high rate of sudden cardiac death of undetermined etiology in younger women
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DOI：
10.1016/s0002-8703(03)00323-5
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发表时间：
2003-10-01
影响因子：
4.8
通讯作者：
Titus, JL
中科院分区：
文献类型：
--
作者：
Chugh, SS;Chung, K;Titus, JL
背景 1989 年至 1998 年间，美国 35 岁至 44 岁女性的心源性猝死估计增加了 21%。相比之下，年龄匹配男性的心源性猝死率呈下降趋势14（-2.8%）。由于已发表的尸检系列中年轻人的代表性不足，心源性猝死的病因值得进一步研究。方法我们回顾了来自 270 名患者、13 年（1984-1996）心源性猝死尸检系列的年轻女性（35-44 岁）的尸检和详细心脏病理结果，并与年龄匹配的男性的结果进行比较。结果 35 至 44 岁的女性占 32%该系列中的所有女性与男性相比，男性占男性总数的 24%（与女性相比，P = .004）。 13 名女性 (50%) 无法确定心源性猝死的推定原因。在女性中，6 例（22%）患有明显的冠状动脉疾病。其他检查结果包括冠状动脉异常 (n = 3)、心肌炎 (n = 2)、肥厚性心肌病 (n = 1)、冠状动脉夹层 (n = 1) 和旁路 (n = 1)。在年轻男性中，只有 24% 的患者心源性猝死的推定原因尚未确定（与年轻女性相比，P = 0.025），而冠状动脉疾病占病例的 40%。 结论 在年轻女性中，尽管进行了尸检和详细的心脏病理检查，但仍有 50% 的病例未能确定心源性猝死的病因；与同龄男性相比增加2倍。鉴于心源性猝死的动态性和多因素性质，可能有必要进行基于人群的全面调查，以进一步调查这种意外的基于性别的差异。
Background Between 1989 and 1998 there was a 21% increase in estimated sudden cardiac death among US women aged 35 to 44 years. In contrast, the sudden cardiac death rate in age-matched men showed a decreasing trend 14 (-2.8%). Due to under-representation of younger adults in published autopsy series, etiologies of sudden cardiac death merit further investigation.Methods We reviewed autopsy and detailed cardiac pathologic findings in younger women (age 35-44 years) from a 270-patient, 13-year (1984-1996) autopsy series of sudden cardiac death, and performed comparisons with findings in age-matched men.Results Women aged 35 to 44 years constituted 32% of all women in the series compared to men, who constituted 24% of total men (P = .004 vs women). A presumptive cause of sudden cardiac death could not be determined in 13 women (50%). Among women, 6 cases (22%) had significant coronary artery disease. Findings in others included coronary artery anomalies (n = 3), myocarditis In (n = 2), hypertrophic cardiomyopathy (n = 1), coronary artery dissection (n = 1) and accessory pathway (n = 1). In younger men, a presumptive cause of sudden cardiac death remained undetermined in only 24% (P = .025 vs younger women), and coronary artery disease accounted for 40% of cases.Conclusions In younger women, despite autopsy and detailed cardiac pathologic examination, an attributable cause of sudden cardiac death was not determined in 50% of cases; a 2-fold increase compared to men of the same age. Given the dynamic and multifactorial nature of sudden cardiac death, comprehensive population-based investigations are likely to be necessary to further investigate this unexpected sex-based disparity.