EFFECT OF HYPERTENSION AND CARDIAC-HYPERTROPHY ON CORONARY-ARTERY MORPHOLOGY IN SUDDEN CARDIAC DEATH

Background Epidemiological studies have shown that hypertension and le ft ventricular hypertrophy (LVH) increase the risk of sudden cardiac d eath (SCD) in patients with severe coronary artery disease (CAD). Howe ver. autopsy studies comparing the morphological substrates for SCD in normotensives and hypertensives are lacking. Methods and Results Hear t weight and coronary plaque morphology were prospectively compared in SCD in 36 hypertensive and 63 normotensive individuals. The frequency of CAD was similar in hypertensives (69%, n=25) and normotensives (73 %, n=46). In 71 hearts with CAD, acute coronary thrombi were present i n 76% of normotensives versus 36% of hypertensives (P=.002). LVH was p resent in 64% of hypertensives versus 33% of normotensives (P=.01) and in 72% of hypertensives with one-vessel disease versus 17% of normote nsives with one-vessel disease (P=.0005), and a healed or acute infarc t without acute thrombus was present in 36% of hypertensives versus 9% of normotensives (P=.007). Heart weight was higher in all cases of pl aque rupture (519 +/- 109 g) than eroded plaque (381 +/- 92 g, P=.0002 ). In contrast to hypertensives, normotensive heart with severe CAD sh owed a stepwise increase in heart weight with one-, two-, and three-ve ssel disease (P=.01). Conclusions Severe CAD is present in most SCD in hypertensive and normotensive individuals, but acute thrombi are more common in normotensives. LVH is an important contributing mechanism o f SCD in hypertensives, especially in cases of one-vessel disease. LVH is associated with plaque rupture and extent of disease in SCD in nor motensives with severe CAD.