ABSTRACT
BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome at the crossroads of multiple co-morbidities; there is no valid treatment for this condition. Defining new phenotypes could play a role in improving treatment and prognosis. AIM: To identify groups with different pathophysiologies by applying a clustering approach to a multicentric cohort of patients with HFpEF. METHODS: A total of 538 patients from the multicentre KaRen study were included. Accurate clinical, biological and ultrasound data are available, with a mean follow-up of 28 months. Based on a clustering analysis, the population was separated into groups based on 55 variables, comparing distribution of deaths and hospitalizations between groups. RESULTS: Three clusters were identified from 356 analysable patients (mean age 76.1±9.31 years; 43.5% men): cluster 1 (n=128) comprised overweight, relatively young men at high cardiovascular risk, in sinus rhythm, with altered renal function; cluster 2 (n=134) comprised women, most of whom had conserved left ventricular function; cluster 3 (n=94) had the highest incidence of mitral regurgitation, atrial remodelling and rhythm disorders. There were no significant differences, only a trend towards early mortality in cluster 3. CONCLUSIONS: Clustering analysis seems to be effective at individualizing subgroups with different physiopathologies in HFpEF. The clinical relevance of these phenotypes needs to be studied, and may concern treatment strategy more than prognostic differences.
Subject(s)
Heart Failure/physiopathology , Stroke Volume , Ventricular Function, Left , Age Factors , Aged , Aged, 80 and over , Cause of Death , Cluster Analysis , Comorbidity , Disease Progression , Female , France , Health Status , Heart Failure/diagnosis , Heart Failure/mortality , Heart Failure/therapy , Hospitalization , Humans , Male , Middle Aged , Phenotype , Prognosis , Risk Factors , Sex Factors , Sweden , Syndrome , Time FactorsABSTRACT
The assessment of myocardial work (MW) by pressure-strain loops is a recently introduced tool for the assessment of myocardial performance. Aim of the present study is to evaluate the relationship between myocardial work and exercise tolerance in patients with dilated cardiomyopathy (DCM). 51 patients with DCM (mean age 57 ± 13 years, left ventricular ejection fraction: 32 ± 9%) underwent cardiopulmonary exercise test (CPET) to assess exercise performance. 22 patients (43%) had left or right bundle branch block with QRS duration > 120 ms. Trans-thoracic echocardiography (TTE) was performed before CPET. The following indices of myocardial work (MW) were measured regionally and globally: constructive work (CW), wasted work (WW), and work efficiency (WE). Left ventricular dyssynchrony (LV-DYS) was defined by the presence of septal flash or apical rocking at TTE. LV-DYS was observed in 16 (31%) patients and associated with lower LV ejection fraction (LVEF), lower global and septal WE, and higher global and septal WW. In patients with LV-DYS, septal WE was the only predictor of exercise capacity at multivariable analysis (ß = 0.68, p = 0.03), whereas LVEF (ß = 0.47, p = 0.05) and age (ß = - 0.42, p = 0.04) were predictors of exercise capacity in patients without LV-DYS. In patients with DCM, LV-DYS is associated with an heterogeneous distribution of myocardial work. Septal WE is the best predictor of exercise performance in these patients.
