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April 11, 2025IJC Heart & VasculatureOpen Access

Clinical phenotypes of severe atrial cardiomyopathy and their outcome: A cluster analysis

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Why the study?

Atrial cardiomyopathy encompasses patients with diverse demographics and comorbidities, motivating the identification of phenotype groups to compare mortality and atrial fibrillation event rates and assess mortality predictors.

Population

196 patients with severe AtCM from 724 consecutive patients with a dilated LA

Comparison

4 clinical phenotype clusters derived by hierarchical cluster analysis

Design

Hierarchical cluster analysis cohort study

Follow-up

Median of 20.6 months

Key result

In patients with severe atrial cardiomyopathy, four distinct clinical phenotype clusters were identified with significantly different all-cause mortality rates ranging from 10.8% to 29.1%.

Authors

RIRadostina IlievaPKPetar KalaydzhievBSBoris Slavchev

Discussion

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Overview

Phenotype clustering may refine mortality risk assessment in severe atrial cardiomyopathy; leaves open whether targeted interventions improve cluster-specific outcomes.

Study Design

Type

Cohort (n=196)

Multicenter

No

Structured PICO

P
Population
196 patients with severe atrial cardiomyopathy (defined as a dilated left atrium with a volume index ≥ 50 ml/m2), identified from a cohort of 724 consecutive patients with a dilated left atrium.
O
Outcome
Mortality and atrial fibrillation (AF) event rateshard clinical

Main Result

p-value: p=0.045

In patients with severe atrial cardiomyopathy, distinct clinical phenotypes exist with significantly different mortality risks, driven by factors such as heart failure, cancer, and severe tricuspid regurgitation.

Limitations

  • The inclusion criteria for severe atrial cardiomyopathy were less complex than newly proposed definitions.
  • Relatively small sample size may impact generalizability and robustness.
  • Different clustering and linkage methods can produce varying results.
  • The choice of four clusters was based on investigators' discretion.
  • The study population consisted of older patients with advanced disease from a hospital setting, limiting applicability to younger or healthier outpatients.
  • Results are specific to the Bulgarian population.

Cite This Study

Ilieva et al. (2025) conducted a cohort in Severe atrial cardiomyopathy (n=196). Clinical phenotype clusters was evaluated on All-cause mortality (p=0.045). In patients with severe atrial cardiomyopathy, four distinct clinical phenotype clusters were identified with significantly different all-cause mortality rates ranging from 10.8% to 29.1%.

synapsesocial.com/papers/6a1212a2ea48cb855a342b82https://doi.org/10.1016/j.ijcha.2025.101679
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