Sudden cardiac death, altitude & physical activity: A retrospective analysis from the highest Italian region (Aosta valley)

The purpose of this retrospective study is to determine whether there is a link between high-altitude physical activity and sudden cardiac death (SCD). There is general agreement that no cause-and-effect relationship exists between altitude and SCD. However, altitude along with extreme temperatures could represent additional triggers to mortality over mountains. A series of sudden deaths occurred from 2013 to 2019 in the highest Italian region (Aosta Valley) has been revised. 18 SCDs occurred at altitudes from 1200 up to 3375 m were accounted in total. All hearts were explanted and examined according to the procedural guidelines for SCD as updated by the Association for European Cardiovascular Pathology in 2017. Most of the SCD cases were in males older than 42 years. 12 out of 18 deaths (66.67 %) occurred on the second day above 1500 m and 9 victims (50 %) died while engaged in physical exercise. Macroscopic analysis identified coronary artery disease (CAD) in 10 cases, Cardiac Hypertrophy in 4 out of 18 cases; dilated cardiomyopathy was assessed in one case, and hypertensive cardiomyopathy in one case. Microscopic analysis identified 3 Myocardial Infarction (MI) 1 arrhythmogenic cardiomyopathy of the right ventricle, 7 myocardial scleroses with coronary artery stenosis, 2 fibro-fatty infiltrations of the RV, 1 dilated cardiomyopathy and 1 Cardiac Hypertrophy. Although the small sample size, the results emphasize that altitude does not play a major role in triggering the cardiovascular events that can occur in the mountains.