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The autopsy study of 553 cases of sudden cardiac death in Chinese adults

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Abstract

Despite a recent epidemiological study reporting a lower incidence of sudden cardiac death (SCD) in China as compared with that in Western countries, the exact causes of SCD are still unknown. Using a uniform review protocol and diagnostic criteria, a retrospective autopsy study identified 553 cases of SCD in 14,487 consecutive autopsies from eight regions in China representing different geographic and population features. Their ages ranged from 18 to 80 years (median 43.0 years) with a ratio of 4.3/1.0 for male/female. Out-of-hospital deaths and unwitnessed cases accounted for 74.3 and 22.6 %, respectively. The main causes of death were coronary atherosclerotic disease (CAD 50.3 %), myocarditis (14.8 %), and hypertrophic cardiomyopathy (4.5 %), with unexplained sudden death accounting for 12.1 % of the cases. CAD had a proportion of 10.4 % in victims <35 years, lower as compared with 59.0 and 83.0 % in victims aged 35–54 and in victims ≥55 years. On the other hand, myocarditis and unexplained sudden death were major causes and accounted for 34.7 and 22.5 % in victims <35 years. In order to differentiate the degree of the cause–effect relationship between autopsy findings and sudden death, a grading method was used in this series and characterized 24.3 % of findings as certain, 52.9 % as highly probable, and 22.8 % as uncertain. Our data indicated that there most likely are less CAD but more myocarditis and unexplained sudden death in Chinese youth with SCD than in populations from Western countries. Molecular genetic testing should be conducted in those cases with uncertain findings and unexplained sudden death in routine autopsy.

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Acknowledgments

The authors thank the many pathologists from the eight cities of China for their work in collecting data and specimens. The authors also thank Prof. Guangzhao Huang and Prof. Xinshan Chen from Tongji Medical College, Wuhan, for reviewing this manuscript. We appreciate Prof. Laifeng Song and Prof. Yingmao Ruan from Fuwai Hospital, Beijing, for their helpful consultation on cardiac pathology. The statistics analysis was aided by Dr. Zuo Chen from China National Center for Cardiovascular Diseases, Beijing. This work was supported by the National Basic Research Program of China (973 project, Grant no. 2007CB512000 and 2007CB512008 to J. Pu).

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Authors and Affiliations

  1. Department of Pathology and Physiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 Beilishilu Road, Xicheng District, Beijing, 100037, China

    Hongyue Wang & Jielin Pu

  2. Guangzhou Institute of Criminal Technology, Guangzhou, China

    Qingsong Yao

  3. Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

    Shaohua Zhu

  4. School of Forensic Medicine, China Medical University, Shenyang, China

    Guohua Zhang

  5. Department of Forensic Medicine, Xian Jiangtong University School Medicine, Xi’an, China

    Zhenyuan Wang

  6. Department of Forensic Medicine, Kunming Medical University, Kunming, China

    Zhen Li

  7. Department of Pathology, Wuxi People’s Hospital, Nanjing Medical University, Wuxi, China

    Rongchao Sun

  8. Department of Pathology, West China Hospital, Sichuan University, Chengdu, China

    Changli Lu

  9. Forensic Medical Examination Center of Beijing Public Security Bureau, Beijing, China

    Changrong Li

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  1. Hongyue Wang
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  2. Qingsong Yao
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  10. Jielin Pu
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Correspondence to Jielin Pu.

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Wang, H., Yao, Q., Zhu, S. et al. The autopsy study of 553 cases of sudden cardiac death in Chinese adults. Heart Vessels 29, 486–495 (2014). https://doi.org/10.1007/s00380-013-0388-0

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