Clinical Phenotyping and Treatment Response in Patients With Chronic Heart Failure

Figures

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  Figure 1. Flow Diagram of the Study CHF = chronic heart failure; ELMSTAT-HF = EpidemioLogical Multicenter Study for Tailored Treatment in Heart Failure.

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  Figure 2. Expression Patterns and Feature Importance Across Phenogroups Lower levels of the variables are represented by lighter colors, while darker colors indicate higher levels. The importance of each variable in defining the phenogroups is illustrated using bar plots. AF = atrial fibrillation; CRP = C-reactive protein; CRT = cardiac resynchronization therapy; eGFR = estimated glomerular filtration rate; EHFScBS = European Heart Failure Self-care Behaviour Scale; HbA1c = hemoglobin A1c; HF = heart failure; ICD = implantable cardioverter-defibrillator; IVC = inferior vena cava; LA = left atrium; LV = left ventricle; NT-proBNP = N-terminal pro B-type natriuretic peptide; TR = tricuspid regurgitation; γ-GTP = gamma-glutamyl transpeptidase.

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  Figure 3. Cumulative Incidence of Clinical Outcomes Among the 8 Phenogroups (A) All-cause death and HF hospitalization. (B) All-cause death. (C) HF hospitalization. Abbreviations as in Figure 2.

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  Figure 4. Clinical Outcomes by Phenogroups and Receiving RAS Blockers and Beta-Blockers (A) All-cause death and HF hospitalization. (B) All-cause death. (C) HF hospitalization. There were no events in patients without RAS blockers in phenogroup 3. Beta-blockers; (D) All-cause death and HF hospitalization. (E) All-cause death. There were no events in patients without beta-blockers in phenogroup 1. (F) HF hospitalization. RAS = renin-angiotensin system; other abbreviations as in Figure 2.

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  Figure 5. Clinical Outcomes by Phenogroups and Receiving MRAs and SGLT2 Inhibitors (A) All-cause death and HF hospitalization. (B) All-cause death. (C) HF hospitalization. SGLT2 inhibitors; (D) All-cause death and HF hospitalization. (E) All-cause death. There were no events in patients without SGLT2 inhibitors in phenogroup 3. (F) HF hospitalization. MRA = mineralocorticoid receptor antagonists; SGLT2 = sodium-glucose cotransporter 2; other abbreviations as in Figure 2.

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  Central Illustration. Clinical Phenotypes and Differential Outcomes in Chronic HF In this study, patients with chronic HF were classified into 8 phenogroups with distinct baseline characteristics and clinical outcomes using latent class analysis. Among the phenogroups, the phenogroup 5 characterized by older age with small LV and diastolic dysfunction demonstrated unfavorable outcomes with the use of beta-blockers or SGLT2 inhibitors. BMI = body mass index; CKD = chronic kidney disease; LVEF = left ventricular ejection fraction; other abbreviations as in Figures 2 and 5.