Clinical Phenogroups in Heart Failure With Preserved Ejection Fraction

Cohen, Jordana B.; Schrauben, Sarah J.; Zhao, Lei; Basso, Michael; Cvijic, Mary Ellen; Li, Zhuyin; Yarde, Melissa; Wang, Zhaoqing; Bhattacharya, Priyanka; Chirinos, Diana A.; Prenner, Stuart B.; Zamani, Payman; Seiffert, Dietmar; Car, Bruce D.; Gordon, David; Margulies, Kenneth B.; Cappola, Thomas P.; Chirinos, Julio A.

doi:10.1016/j.jchf.2019.09.009

Cited by 226 publications

(146 citation statements)

References 30 publications

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“…Phenotypic presentations of HFpEF may vary widely across patients and determine the choice of diagnostic tests and targeted management plan [ 39 ••, 43 – 46 ]. There are four clinically distinct phenotypes of HFpEF that have been recognized [ 47 ]: Aging phenotype Obesity phenotype Pulmonary hypertension (PH) phenotype Coronary artery disease (CAD) phenotype …”

Section: Hfpef Phenotypesmentioning

confidence: 99%

Heart Failure with Preserved Ejection Fraction—a Concise Review

et al. 2020

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Purpose of Review Heart failure with preserved ejection fraction (HFpEF) is a relatively new disease entity used in medical terminology; however, both the number of patients and its clinical significance are growing. HFpEF used to be seen as a mild condition; however, the symptoms and quality of life of the patients are comparable to those with reduced ejection fraction. The disease is much more complex than previously thought. In this article, information surrounding the etiology, diagnosis, prognosis, and possible therapeutic options of HFpEF are reviewed and summarized. Recent Findings It has recently been proposed that heart failure (HF) is rather a heterogeneous syndrome with a spectrum of overlapping and distinct characteristics. HFpEF itself can be distilled into different phenotypes based on the underlying biology. The etiological factors of HFpEF are unclear; however, systemic low-grade inflammation and microvascular damage as a consequence of comorbidities associated with endothelial dysfunction, oxidative stress, myocardial remodeling, and fibrosis are considered to play a crucial role in the pathogenesis of a disease. The H 2 FPEF score and the HFpEF nomogram are recently validated highly sensitive tools employed for risk assessment of subclinical heart failure. Summary Despite numerous studies, there is still no evidence-based pharmacotherapy for HFpEF and the mortality and morbidity associated with HFpEF remain high. A better understanding of the etiological factors, the impact of comorbidities, the phenotypes of the disease, and implementation of machine learning algorithms may play a key role in the development of future therapeutic strategies.

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Section: Hfpef Phenotypesmentioning

confidence: 99%

Heart Failure with Preserved Ejection Fraction—a Concise Review

et al. 2020

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“…Lack of evidence-based treatment and diverse phenotypes remain challenging issues in HFpEF management. So far, the approach is mostly individualized and heavily focused on phenotypes and comorbidities as presenting features [ 2 , 11 , 20 , 21 ]. While the pathophysiology-based phenotyping appeared to be a promising approach, its clinical application is restricted by the mixed-mechanism nature of HFpEF [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…While the pathophysiology-based phenotyping appeared to be a promising approach, its clinical application is restricted by the mixed-mechanism nature of HFpEF [ 2 ]. Another pragmatic perspective is to focus on clinical variables, such as comorbidity, which were not only easily spotted by physicians but also associated with different long-term outcomes [ 2 , 21 ]. As common phenotypes were observed across population, cardiology experts proposed specific treatment approach and distinct therapeutic response for those frequently presented phenotypes [ 2 , 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…Another pragmatic perspective is to focus on clinical variables, such as comorbidity, which were not only easily spotted by physicians but also associated with different long-term outcomes [ 2 , 21 ]. As common phenotypes were observed across population, cardiology experts proposed specific treatment approach and distinct therapeutic response for those frequently presented phenotypes [ 2 , 20 , 21 ]. Yet, slight phenotype variations existed among regional and ethnic groups, calling for more local research on HFpEF patients [ 1 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Phenotypes and Age-Related Differences in Presentation, Treatment, and Outcome of Heart Failure with Preserved Ejection Fraction: A Vietnamese Multicenter Research

Nguyen

Tran

et al. 2021

Cardiology Research and Practice

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Background. Heart failure with preserved ejection fraction (HFpEF) is a rising health problem with heterogeneous presentation and no evidence-based treatment. While Southeast Asia reported the highest mortality and morbidity among Asian population, little is known about the Vietnamese population, including patient characteristics, prescribing pattern and mortality rate. Methods. We conducted an observational study on 477 patients diagnosed with HFpEF from seven hospitals in Southern Vietnam from January 2019 to December 2019. Results. Mean age was 67.6 (40.9% < 65 years). 62.3% were female. 82.4% were diagnosed within 5 years. Dyspnea, congestion, and hypoperfusion on admission were noted in 63.9%, 48.8%, and 4.6% of the patients, respectively. Median ejection fraction was 63%. Valvular heart disease (VHD) was the leading cause of heart failure (35.9%). 78.6% had at least two comorbidities, mostly hypertension (68.6%). 30.6% of the patients were hospitalized, with a median stay of 7.0 (4.0–10.0) days and inhospital mortality of 4.8%. Older patients (≥65 years) were more likely to be females (OR = 1.52); had multimorbid conditions (OR = 3.14), including hypertension (OR = 4.28), diabetes (OR = 1.73), coronary artery disease (CAD) (OR = 2.50), dyslipidemia (OR = 1.94), and chronic kidney disease (OR = 2.44); and were more frequently prescribed statin (OR = 3.15). Younger individuals (<65 years) were associated with higher mineralocorticoid antagonist uptake (OR = 0.52) and VHD (OR = 0,40). Prescription rate for renin-angiotensin-aldosterone system inhibitor, beta blocker, mineralocorticoid antagonist, and loop diuretic was 72.5%, 59.1%, 43.0%, and 60.6%, respectively. Four phenotypes were identified, including the lean/elderly/multimorbid; congestive/metabolic; CAD-induced; and younger/atrial fibrillation (AF)/VHD. The novel phenotype “younger/AF/VHD” exhibited high symptom burden and poor functional capacity despite being the youngest and least multimorbid. The “lean/elderly/multimorbid” phenotype demonstrated the highest symptom severity and inhospital mortality. Conclusions. Our research highlights a younger, predominantly female population with high disease burden. The four novelly identified phenotypes provide contemporary and pragmatic insights into a phenotype-guided approach, exclusively targeting the Vietnamese population.

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“…To overcome this problem, the precise calculating ability of artificial intelligence helped to stratify HFpEF. Indeed, using several machine-learning algorithms, previous studies clarified the phenotypes and therapeutic strategies for HFpEF; however, the features of heart failure with mid-range ejection fraction may influence the features of unknown phenotypes and RV diastolic function was not taught in previous studies (9)(10)(11)(12)(13). Although RV function plays an important role in the pathophysiology of HFpEF (14), there is a lack of guidance for the assessment and quantification of RV diastolic function (15).…”

Section: Introductionmentioning

confidence: 99%

Different Pathophysiology and Outcomes of Heart Failure With Preserved Ejection Fraction Stratified by K-Means Clustering

Harada

Asanoi

Noto

et al. 2020

Front. Cardiovasc. Med.

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Background: Stratified medicine may enable the development of effective treatments for particular groups of patients with heart failure with preserved ejection fraction (HFpEF); however, the heterogeneity of this syndrome makes it difficult to group patients together by common disease features. The aim of the present study was to find new subgroups of HFpEF using machine learning.Methods: K-means clustering was used to stratify patients with HFpEF. We retrospectively enrolled 350 outpatients with HFpEF. Their clinical characteristics, blood sample test results and hemodynamic parameters assessed by echocardiography, electrocardiography and jugular venous pulse, and clinical outcomes were applied to k-means clustering. The optimal k was detected using Hartigan's rule.Results: HFpEF was stratified into four groups. The characteristic feature in group 1 was left ventricular relaxation abnormality. Compared with group 1, patients in groups 2, 3, and 4 had a high mean mitral E/e′ ratio. The estimated glomerular filtration rate was lower in group 2 than in group 3 (median 51 ml/min/1.73 m2 vs. 63 ml/min/1.73 m2p < 0.05). The prevalence of less-distensible right ventricle and atrial fibrillation was higher, and the deceleration time of mitral inflow was shorter in group 3 than in group 2 (93 vs. 22% p < 0.05, 95 vs. 1% p < 0.05, and median 167 vs. 223 ms p < 0.05, respectively). Group 4 was characterized by older age (median 85 years) and had a high systolic pulmonary arterial pressure (median 37 mmHg), less-distensible right ventricle (89%) and renal dysfunction (median 54 ml/min/1.73 m2). Compared with group 1, group 4 exhibited the highest risk of the cardiac events (hazard ratio [HR]: 19; 95% confidence interval [CI] 8.9–41); group 2 and 3 demonstrated similar rates of cardiac events (group 2 HR: 5.1; 95% CI 2.2–12; group 3 HR: 3.7; 95%CI, 1.3–10). The event-free rates were the lowest in group 4 (p for trend < 0.001).Conclusions: K-means clustering divided HFpEF into 4 groups. Older patients with HFpEF may suffer from complication of RV afterload mismatch and renal dysfunction. Our study may be useful for stratified medicine for HFpEF.

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Clinical Phenogroups in Heart Failure With Preserved Ejection Fraction

Cited by 226 publications

References 30 publications

Heart Failure with Preserved Ejection Fraction—a Concise Review

Heart Failure with Preserved Ejection Fraction—a Concise Review

Clinical Phenotypes and Age-Related Differences in Presentation, Treatment, and Outcome of Heart Failure with Preserved Ejection Fraction: A Vietnamese Multicenter Research

Different Pathophysiology and Outcomes of Heart Failure With Preserved Ejection Fraction Stratified by K-Means Clustering

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