Aetiological classification and prognosis in patients with heart failure with preserved ejection fraction

Abstract

Aims Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with various causes that may influence prognosis. Methods and results We extracted the electronic medical records for 2180 consecutive patients hospitalized between 2016 and 2019 for decompensated heart failure. Using a text mining algorithm looking for a left ventricular ejection fraction ≥50% and plasma brain natriuretic peptide level >100 pg/mL, we identified 928 HFpEF patients. We screened for a prevailing cause of HFpEF according to European guidelines and found that 418 (45.0%) patients had secondary HFpEF due to either myocardial (n = 125, 13.5%) or loading condition abnormalities (n = 293, 31.5%), while the remaining 510 (55.0%) patients had idiopathic HFpEF. We assessed the association between the causes of HFpEF and survival collected up to 31 December 2020 using Cox proportional hazards analysis. Even though patients with idiopathic HFpEF were older, frequently female, and had frequent co‐morbidities and a higher crude mortality rate compared with secondary HFpEF patients, their prognosis was similar after adjustment for age and sex. Unsupervised clustering analysis revealed three main phenogroups with different distribution of idiopathic vs. secondary HFpEF. The phenogroup with the highest proportion of idiopathic HFpEF (69%) had (i) an excess rate of non‐cardiac co‐morbidities including chronic obstructive pulmonary disease (31%) or obesity (41%) and (ii) a better prognosis compared with the two other phenogroups enriched with secondary HFpEF. Conclusions Aetiological classification provides clinical and prognostic information and may be useful to better decipher the clinical heterogeneity of HFpEF.

The prevalence and survival of pulmonary hypertension due to left heart failure: A retrospective analysis of a multicenter prospective cohort study

“…Previous studies reported that HFrEF of ischemic origin had higher mortality than HFrEF due to non-ischemic causes ( 25 , 26 ). A study exploring the prognosis in patients with HFpEF reported a specific phenogroup containing all patients with CAD had significantly different mortality compared with other phenogroups ( 27 ). However, our study revealed no significant differences in mortality between CAD and without CAD groups in HFrEF and HFpEF ( Supplementary Figure 2 ).…”

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“…Повысить качество и продолжительность жизни пациентов с ХСН можно с помощью этиотропной и патогенетической терапии. Персонифицированный подход к лечению прежде всего диктует необходимость учета этиологической неоднородности группы пациентов с ХСН [13][14][15]. Поскольку состояния, которые осложняются развитием сердечной недостаточности, различны по своему патогенезу, создание универсальных алгоритмов терапии затруднительно [11,14].…”

A Heart Failure Model Established by Pressure Overload Caused by Abdominal Aortic Contraction in Rat

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