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Heart Failure Reviews

, Volume 24, Issue 6, pp 847–866 | Cite as

Sudden death in heart failure with preserved ejection fraction and beyond: an elusive target

  • Antonis S. ManolisEmail author
  • Antonis A. Manolis
  • Theodora A. Manolis
  • Helen Melita
Article

Abstract

Heart failure (HF) with preserved ejection fraction (HFpEF) represents half of HF patients, who are more likely older, women, and hypertensive. Mortality rates in HFpEF are higher compared with age- and comorbidity-matched non-HF controls and lower than in HF with reduced ejection fraction (HFrEF); the majority (50–70%) are cardiovascular (CV) deaths. Among CV deaths, sudden death (SD) (~ 35%) and HF-death (~ 20%) are the leading cardiac modes of death; however, proportionally, CV deaths, SD, and HF-deaths are lower in HFpEF, while non-CV deaths constitute a higher proportion of deaths in HFpEF (30–40%) than in HFrEF (~ 15%). Importantly, the underlying mechanism of SD has not been clearly elucidated and non-arrhythmic SD may be more prominent in HFpEF than in HFrEF. Furthermore, there is no specific strategy for identifying high-risk patients, probably due to wide heterogeneity in presentation and pathophysiology of HFpEF and a plethora of comorbidities in this population. Thus, the management of HFpEF remains problematic due to paucity of data on the clinical benefits of current therapies, which focus on symptom relief and reduction of HF-hospitalization by controlling fluid retention and managing risk-factors and comorbidities. Matching a specific pathophysiology or mode of death with available and novel therapies may improve outcomes in HFpEF. However, this still remains an elusive target, as we need more information on determinants of SD. Implantable cardioverter-defibrillators (ICDs) have changed the landscape of SD prevention in HFrEF; if ICDs are to be applied to HFpEF, there must be a coordinated effort to identify and select high-risk patients.

Keywords

Heart failure Heart failure with preserved ejection fraction Sudden death Sudden cardiac death Non-cardiac sudden death Cardiovascular death Non-cardiovascular death Left ventricular dysfunction Ventricular tachycardia Ventricular fibrillation Cardiac arrest 

Abbreviations

ACEI

Angiotensin converting enzyme inhibitor

AF

Atrial fibrillation

ARB

Angiotensin receptor blocker

BNP

Brain natriuretic peptide

CAD

Coronary artery disease

CKD

Chronic kidney disease

CMR

Cardiac magnetic resonance (imaging)

CV

Cardiovascular

DM

Diabetes mellitus

ECG

Electrocardiogram

EP

Electrophysiology

HF

Heart failure

HFmrEF

Heart failure with mid-range ejection fraction

HFpEF

Heart failure with preserved ejection fraction

HFrEF

Heart failure with reduced ejection fraction

ICD

Implantable cardioverter defibrillator

LGE

Late gadolinium enhancement

LV

Left ventricle(−ular)

LVEF

Left ventricular ejection fraction

LVH

Left ventricular hypertrophy

MI

Myocardial infarction

MRA

Mineralocorticoid receptor antagonist

NICM

Non-ischemic cardiomyopathy

PCI

Percutaneous coronary intervention

RCT

Randomized controlled trial

RV

Right ventricular

SCD

Sudden cardiac death

SD

Sudden death

STEMI

ST elevation myocardial infarction

VF

Ventricular fibrillation

VT

Ventricular tachycardia

VTA

Ventricular tachyarrhythmia

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Third Department of CardiologyAthens University School of MedicineAthensGreece
  2. 2.Patras University School of MedicinePatrasGreece
  3. 3.Red Cross HospitalAthensGreece
  4. 4.Onassis Cardiac Surgery CenterAthensGreece

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