Phenotyping of acute decompensated heart failure with preserved ejection fraction. Issue 19 (5th January 2022)

• Record Type: Journal Article
• Authors: Sotomi, Yohei; Hikoso, Shungo; Komukai, Sho; Sato, Taiki; Oeun, Bolrathanak; Kitamura, Tetsuhisa; Nakagawa, Akito; Nakatani, Daisaku; Mizuno, Hiroya; Okada, Katsuki; Dohi, Tomoharu; Sunaga, Akihiro; Kida, Hirota; Seo, Masahiro; Yano, Masamichi; Hayashi, Takaharu; Nakagawa, Yusuke; Tamaki, Shunsuke; Ohtani, Tomohito; Yasumura, Yoshio; Yamada, Takahisa; Sakata, Yasushi
• Is Part Of: Heart. Volume 108:Issue 19(2022)
• Page Start: 1553
• Page End: 1561
• Publication Date: 2022-01-05
• Subjects: heart failure with preserved ejection fraction; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2021-320270
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: The pathophysiological heterogeneity of heart failure with preserved ejection fraction (HFpEF) makes the conventional 'one-size-fits-all' treatment approach difficult. We aimed to develop a stratification methodology to identify distinct subphenotypes of acute HFpEF using the latent class analysis. Methods: We established a prospective, multicentre registry of acute decompensated HFpEF. Primary candidates for latent class analysis were patient data on hospital admission (160 features). The patient subset was categorised based on enrolment period into a derivation cohort (2016–2018; n=623) and a validation cohort (2019–2020; n=472). After excluding features with significant missingness and high degree of correlation, 83 features were finally included in the analysis. Results: The analysis subclassified patients (derivation cohort) into 4 groups: group 1 (n=215, 34.5%), characterised by arrythmia triggering (especially atrial fibrillation) and a lower comorbidity burden; group 2 (n=77, 12.4%), with substantially elevated blood pressure and worse classical HFpEF echocardiographic features; group 3 (n=149, 23.9%), with the highest level of GGT and total bilirubin and frequent previous hospitalisation for HF and group 4 (n=182, 29.2%), with infection-triggered HF hospitalisation, high C reactive protein and worse nutritional status. The primary end point—a composite of all-cause death and HF readmission—significantly differed between the groups (log-rank p<0.001). These findings were consistent in the validation cohort. Conclusions: This study indicated the feasibility of clinical application of the latent class analysis in a highly heterogeneous cohort of patients with acute HFpEF. Patients can be divided into 4 phenotypes with distinct patient characteristics and clinical outcomes. Trial registration number: UMIN000021831.