MEDICAL HYPOTHESES AND RESEARCH
VOL. 1, No. 4, October 2004


X. K. Xu  [2004] Med Hypotheses Res 1: 253-260.


Right Ventricular Fatty Replacement as the Possible
Missing Link between Fatty Liver and Sudden Death


X. Karen Xu*

Department of Pathology, Lexington Medical Center, West Columbia, South Carolina
29169, USA


Abstract. The association between fatty liver and sudden death has long been
suspected, particularly in forensic pathology, but its pathogenic mechanisms remain elusive.
This report describes several cases of fatty liver-associated sudden death in connection with
extensive right ventricular fatty replacement. On the basis of the findings described in this
study, it is hypothesized that extensive fatty replacement of the right ventricle is the missing
link between fatty liver and sudden death, particularly in alcoholics and possibly also in
obese and diabetic patients. In support of this proposed link, relevant literature on
arrhythmogenic right ventricular cardiomyopathy, alcoholic and nonalcoholic
steatosis/steatohepatitis, and fatty liver-associated sudden death is also discussed.  It is
suggested that right ventricular fatty replacement associated with fatty liver may represent a
unique subset of arrhythmogenic right ventricular cardiomyopathy caused by chronic lipid
metabolic disturbances.


*Address all correspondence to: Dr. X. Karen Xu, M.D., Ph.D., Department of Pathology,
Lexington Medical Center, West Columbia, South Carolina 29169 (USA). E-mail:
kxu@lexhealth.org



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