Abstract

Sudden cardiac death (SCD) is the leading cause of cardiovascular mortality in patients with coronary artery disease without severe systolic dysfunction and in heart failure with preserved ejection fraction. From a global health perspective, while risk may be lower, the absolute number of SCDs in patients with left ventricle ejection fraction >35% is higher than in those with severely reduced left ventricle ejection fraction (defined as ≤35%). Despite these observations and the high amount of available data, to date there are no clear recommendations to reduce the sudden cardiac death burden in the population with mid-range or preserved left ventricle ejection fraction. Ongoing improvements in risk stratification based on electrophysiological and imaging techniques point towards a more precise identification of patients who would benefit from ICD implantation, which is still an unmet need in this subset of patients. The aim of this review is to provide a state-of-the-art approach in sudden cardiac death risk stratification of patients with mid-range and preserved left ventricular ejection fraction and one of the following etiologies: ischemic cardiomyopathy, heart failure, atrial fibrillation or myocarditis.

Highlights

  • Sudden cardiac death (SCD) is an event of presumed cardiac origin occurring suddenly and unexpectedly in an otherwise stable patient [1]

  • We reported about currently published studies and clinical trials, selected after a systematic research on PubMed including the keywords “sudden cardiac death” and “preserved” or “mid-range”

  • A light in the shade is provided by the PRESERVE EF study [46], which proposed a fascinating two-step algorithm for patients with ICM and preserved LVEF (pLVEF)

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Summary

Introduction

Sudden cardiac death (SCD) is an event of presumed cardiac origin occurring suddenly and unexpectedly in an otherwise stable patient [1]. The implantable cardioverter defibrillator (ICD) represented a turning point in the prevention of SCD, with several landmark trials demonstrating its efficacy in selected populations [4,5]. Building on these studies, ICD is currently recommended to reduce the risk of death in patients with severely reduced (≤35%) left ventricle ejection fraction (LVEF) (primary prevention) and in cardiac arrest survivors (secondary prevention) [6,7]. SCD is the most common cause of cardiovascular death in patients with CAD without severe systolic dysfunction and in patients with heart failure with preserved ejection fraction (HFpEF [9]). Other conditions at high risk of SCD with preserved ejection fraction, such as idiopathic dilated cardiomyopathy, hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), channelopathies and valvular diseases, are beyond the scope of this paper

Epidemiology
Basal ECG
Autonomic Dysfunction
Echocardiography
Cardiac Magnetic Resonance
Nuclear Imaging
Electrophysiological Study
Study Design
Aim of the Study
31 December 2024
Risk Stratification of SCD in Patients with HFpEF
Risk Stratification of SCD in Patients with Atrial Fibrillation
Emerging Risk Factors
Findings
Conclusions
Full Text
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