Key result
HFpEF patients with phenotype 2 (older males with cardiorenal insufficiency) had a significantly higher risk of all-cause mortality compared to phenotype 1 (HR 4.6094).
Why the study?
Patients with HFpEF have high morbidity and poor prognosis, and distinct clinical phenotypes exist whose specific impacts on prognosis required further investigation.
Does clinical phenotyping using K-means clustering predict all-cause mortality in patients with HFpEF?
Cohort (n=189)
No
Does clinical phenotyping using K-means clustering predict all-cause mortality in patients with HFpEF?
Hazard Ratio: 4.6094 (95% CI 2.0373–10.4291)
p-value: p=0.0002
K-means clustering identifies four distinct clinical phenotypes of HFpEF, demonstrating that older age and renal insufficiency are decisive factors for increased all-cause mortality.
Cardiac-renal insufficiency phenotype marks highest HFpEF mortality risk; K-means clustering leaves open prospective validation before clinical use.
Background Patients with heart failure with preserved ejection fraction are characterized by high morbidity and poor prognosis. Previous studies have shown that there are several different phenotypes of HFpEF, each with distinct clinical features, and we used k-means clustering to determine the clinical phenotypes of patients with HFpEF and to investigate their impact on prognosis. Methods We first screened 189 patients with HFpEF who met the inclusion criteria and stratified them using K-mean clustering according to clinical characteristics, routine blood and biochemical parameters, echocardiography, and comorbidities, and determined the optimal number of prime hearts using the error sum of squares. Kaplan-Meier survival curves were then used to assess the impact of each clinical phenotype on all-cause mortality; Cox regression risk models were used to estimate the correlation between each clinical phenotype and long-term prognosis. Results Four HFpEF phenotypes were identified: phenotype 1 was a young patient with poor cardiac function but preserved renal function; phenotype 2 was an older male patient with cardiac and renal insufficiency; phenotype 3 had preserved LA morphology and function, and all patients in this group had higher ejection fractions than the other three groups; phenotype 4 was an older female patient with preserved cardiac function but poor renal function. The Kaplan-Meier survival analysis found that patients with phenotype 2 had significantly lower survival rates than the other three groups, and the Cox proportional risk analysis also found that phenotype 2 showed the highest risk of all-cause mortality (HR = 4.6094; 95% CI: 2.0373, 10.4291). Conclusion K-means cluster analysis classified HFpEF patients into four clinical phenotypes, and the analysis revealed that old age and renal insufficiency were decisive factors affecting prognosis, so the staging and treatment of HFpEF patients should focus on age and renal function.
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Xu et al. (2023) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=189). Phenotype 2 (older male with cardiorenal insufficiency) vs. Phenotype 1 (younger with poor cardiac function but preserved renal function) was evaluated on All-cause mortality (HR 4.6094, 95% CI 2.0373, 10.4291, p=0.0002). HFpEF patients with phenotype 2 (older males with cardiorenal insufficiency) had a significantly higher risk of all-cause mortality compared to phenotype 1 (HR 4.6094).
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