Medical Hypotheses and Research

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 liverassociated 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. R E SE A R C H A R T IC L E *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: [email protected]