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Sudden Death in Men Versus Women with Heart Failure

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Abstract

Purpose of Review

Sudden cardiac death (SCD) represents the most feared complication of heart failure (HF). This review intends to provide insight on our current knowledge of sex differences in SCD mechanisms, prevention, and management in HF patients.

Recent Findings

Women with HF present a better prognosis than men and have a lower incidence of SCD, irrespective of the presence of ischemic heart disease and age. The influence of sex hormones, sex differences in intracellular calcium handling, and a differential myocardial remodeling may explain such a gap between men and women. Both HF drugs and ventricular arrhythmias ablation seems also useful for the management of women at risk of SCD, but special care must be taken with the use of antiarrhythmic QT-prolonging drugs. However, implantable cardioverter defibrillator (ICD) use has not been shown to be equally effective in women than men.

Summary

Sex-specific recommendations regarding SCD in HF are still lacking due to the scarcity of information and the under-representation of women in clinical trials. Further investigation is required to provide specific risk stratification models in women. Cardiac magnetic resonance imaging, genetics development, and personalized medicine will probably play an increasing role in this evaluation.

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Abbreviations

CRT:

Cardiac resynchronization therapy

HF:

Heart failure

HFpEF:

Heart failure with preserved ejection fraction

HFrEF:

Heart failure with reduced ejection fraction

ICD:

Implantable cardioverter defibrillator

LVEF:

Left ventricle ejection fraction

NYHA:

New York Heart Association

SCD:

Sudden cardiac death

VT:

Ventricular tachycardia

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Acknowledgements

The editors would like to thank Dr. Tomas Datino for handling the review of this manuscript.

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Authors and Affiliations

  1. Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, Madrid, Spain

    Jorge Martínez-Solano & Manuel Martínez-Sellés

  2. Universidad Europea, Universidad Complutense, Madrid, Spain

    Manuel Martínez-Sellés

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  1. Jorge Martínez-Solano
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  2. Manuel Martínez-Sellés
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Correspondence to Manuel Martínez-Sellés.

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Martínez-Solano, J., Martínez-Sellés, M. Sudden Death in Men Versus Women with Heart Failure. Curr Heart Fail Rep 20, 129–137 (2023). https://doi.org/10.1007/s11897-023-00596-z

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