What causes sudden death in patients with chronic heart failure and a reduced ejection fraction?

European Heart Journal
M Packer

Abstract

Sudden death characterizes the mode of demise in 30-50% of patients with chronic heart failure and a reduced ejection fraction. Occasionally, these events have an identifiable pathophysiological trigger, e.g. myocardial infarction, catecholamine surges, or electrolyte imbalances, but in most circumstances, there is no acute precipitating mechanism. Instead, adverse left ventricular remodelling and fibrosis creates an exceptionally fragile and highly vulnerable substrate, which can be characterized using the model developed in theoretical physics of 'self-organizing criticality'. This framework has been applied to describe the genesis of avalanches, nodes of traffic congestion unrelated to an accident, the abrupt system-wide failure of electrical grids, and the initiation of cancer and neurodegenerative diseases. Self-organizing criticality within the ventricular myocardium relies on complex adaptations to progressive stress and stretch, which evolve inevitably to an abrupt end (termed 'cascading failure'), even though the rate of deterioration of the underlying disease process has not changed. The result is acute circulatory collapse (i.e. sudden death) in the absence of an identifiable triggering event. Cascading failure in a ...Continue Reading

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Citations

Oct 2, 2019·European Heart Journal·Thomas F Lüscher
Jan 4, 2020·Journal of Thrombosis and Thrombolysis·Richard C BeckerSakthivel Sadayappan
Jan 7, 2020·European Heart Journal·A John CammJan Steffel
Jan 4, 2021·European Heart Journal·Héctor BuenoJohann Bauersachs
Nov 21, 2020·European Heart Journal·Thomas F Lüscher
Jan 16, 2021·European Heart Journal·Johann Bauersachs
Oct 30, 2020·American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions·Sijing ChengWei Hua
Sep 14, 2019·European Heart Journal·Thomas F Lüscher
Nov 21, 2020·European Heart Journal·Thomas F Lüscher
Mar 10, 2021·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Herbert NägeleMatthias P Nägele
Feb 25, 2021·European Journal of Preventive Cardiology·Giuseppe BorianiRenato Pietro Ricci
Mar 12, 2021·European Journal of Heart Failure·Milton Packer, John J V McMurray
Jun 12, 2021·Journal of the American College of Cardiology·Andrea Di MarcoMatthias Schmitt
Aug 2, 2021·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Dimitrios SfairopoulosPanagiotis Korantzopoulos

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