ArticleScientific reports2025
Distinct mortality patterns and sudden cardiac death mechanisms in heart failure with a preserved ejection fraction.
Article in Scientific reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Sudden cardiac death (SCD) is a leading cause of mortality in heart failure (HF), yet its incidence, mechanisms, and predictors in heart failure with preserved ejection fraction (HFpEF) remain poorly characterized. We conducted a prospective study of 2331 patients hospitalized for decompensated HF, stratifying them into HFpEF (n = 754), HF with mid-range ejection fraction (HFmrEF, n = 369), and HF with reduced ejection fraction (HFrEF, n = 1208). Over a median 25-month follow-up, 298 patients (12.8%) experienced SCD. HFpEF patients had the lowest SCD incidence (5.9%) compared to HFmrEF (13.8%) and HFrEF (16.7%) (p < 0.01). Asystole predominated in HFpEF SCD cases (52.9%), whereas ventricular tachyarrhythmias dominated in HFmrEF and HFrEF. In multivariate competing risk analysis, NYHA class III (cause-specific hazard ratio [csHR] 2.04, 95% CI 1.20-3.45, p < 0.01; subdistribution hazard ratio [sHR] 1.56, 95% CI 1.16-1.96, p = 0.01) and prolonged QTc interval > 480 ms (csHR 1.63, 95% CI 1.03-2.55, p = 0.01; sHR 1.57, 95% CI 1.04-2.38, p = 0.03) independently predicted SCD in patients with HFpEF. These findings reveal distinct SCD patterns in HFpEF and underscore the need for phenotype-specific risk stratification and prevention strategies.
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