What question did this study set out to answer?

This review explores the risk factors and predictors of sudden cardiac death in heart failure patients with preserved and mildly reduced ejection fraction.

April 18, 2026Journal of Clinical MedicineOpen Access

Predicting Sudden Cardiac Death in Heart Failure with Mildly Reduced/Preserved Left Ventricular Ejection Fraction: A Clinical Review

View Full Paper

Ask AI

Bookmark

Why the study?

Specific data on the risk of sudden cardiac death and ventricular arrhythmias in patients with HFpEF and HFmrEF are lacking.

Key Points

This review explores the risk factors and predictors of sudden cardiac death in heart failure patients with preserved and mildly reduced ejection fraction.
Clinical review of literature on heart failure with preserved ejection fraction (HFpEF) and mildly reduced ejection fraction (HFmrEF).
Analysis of rates of sudden cardiac death (SCD), ventricular tachycardia (VT), and ventricular fibrillation (VF).
Examination of risk factors like age, gender, and NT-proBNP levels.
Comparison of drug effects using dapagliflozin and finerenone in SCD prevention.
Incidence of sudden cardiac death in HFpEF is reported at 1.3% per year.
Identified higher risk group includes HFpEF patients with specific clinical features including LBBB and elevated NT-proBNP.
Dapagliflozin treatment showed lower SCD rates compared to other treatments among some patients.
No significant benefit of finerenone or glifozins in reducing SCD incidence was observed in HFpEF patients.

Structured PICO

Population

Patients with heart failure with mildly reduced (HFmrEF) or preserved (HFpEF) left ventricular ejection fraction

Outcome

Sudden cardiac death (SCD)hard clinical

Arrhythmic sudden cardiac death in HFpEF is likely driven by bradyarrhythmia rather than just VT/VF, and current drugs have not demonstrated efficacy in preventing SCD in this population.

Implication

May limit role of primary prevention ICDs in HFpEF/HFmrEF; extends SCD and VT/VF risk data to these understudied phenotypes.

Abstract

Cardiac arrest is a way of demise of patients who are affected by heart failure (HF), being more frequent in those with HF with a reduced left ventricular ejection fraction (HFrEF), and is, as such, responsible for 30–50% of cardiac death. Specific data on the risk of sudden cardiac death (SCD) related to HF with a preserved ejection fraction (HFpEF) and HF with a mildly reduced ejection fraction (HFmrEF) are lacking, as well as data regarding ventricular arrhythmias in this population. Considering the 0.3% person/year incidence rate of investigator-reported ventricular tachycardia (VT) and ventricular fibrillation (VF), the rate of SCD in the analyzed population seems to be 1.3% per year. Age, gender, history of diabetes and myocardial infarction, left bundle branch block (LBBB) on electrocardiogram (ECG), and a natural logarithm of N-terminal pro B-type natriuretic peptide (NT-proBNP), identified a subgroup of HFpEF patients with a higher risk (5-year cumulative incidence of 11%) of sudden death (SD). In HFpEF patients, both glifozins and finerenone did not demonstrate a beneficial effect on SCD incidence in comparison to placebo. A significantly lower rate of SCD emerged in patients who were treated with dapaglifozin (10 vs. 26 pts) among patients with HF with an improved ejection fraction (HFimpEF), who were defined as patients with a previous left ventricular ejection fraction (LVEF) < 40%. Promising methods discussed include cardiac magnetic resonance, myocardial scintigraphy, genetic assessment, and electrophysiologic studies for predicting SCD in those patients. In conclusion, arrhythmic SCD in HFpEF patients should not be considered merely as an effect of VT/VF; bradyarrhythmia is probably more frequent and dangerous. The effects of drugs in preventing SCD in HFpEF have not been demonstrated yet.