RT Journal Article
SR Electronic
T1 Identification of novel pheno-groups in heart failure with preserved ejection fraction using machine learning
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 342
OP 349
DO 10.1136/heartjnl-2019-315481
VO 106
IS 5
A1 Åsa K Hedman
A1 Camilla Hage
A1 Anil Sharma
A1 Mary Julia Brosnan
A1 Leonard Buckbinder
A1 Li-Ming Gan
A1 Sanjiv J Shah
A1 Cecilia M Linde
A1 Erwan Donal
A1 Jean-Claude Daubert
A1 Anders Mälarstig
A1 Daniel Ziemek
A1 Lars Lund
YR 2020
UL http://heart.bmj.com/content/106/5/342.abstract
AB Objective Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome. We aimed to derive HFpEF phenotype-based groups ('phenogroups') based on clinical and echocardiogram data using machine learning, and to compare clinical characteristics, proteomics and outcomes across the phenogroups.Methods We applied model-based clustering to 32 echocardiogram and 11 clinical and laboratory variables collected in stable condition from 320 HFpEF outpatients in the Karolinska-Rennes cohort study (56% female, median 78 years (IQR: 71–83)). Baseline proteomics and the composite end point of all-cause mortality or heart failure (HF) hospitalisation were used in secondary analyses.Results We identified six phenogroups, for which significant differences in the prevalence of concomitant atrial fibrillation (AF), anaemia and kidney disease were observed (p<0.05). Fifteen out of 86 plasma proteins differed between phenogroups (false discovery rate, FDR<0.05), including biomarkers of HF, AF and kidney function. The composite end point was significantly different between phenogroups (log-rank p<0.001), at short-term (100 days), mid-term (18 months) and longer-term follow-up (1000 days). Phenogroup 2 was older, with poorer diastolic and right ventricular function and higher burden of risk factors as AF (85%), hypertension (83%) and chronic obstructive pulmonary disease (30%). In this group a third experienced the primary outcome to 100 days, and two-thirds to 18 months (HR (95% CI) versus phenogroups 1, 3, 4, 5, 6: 1.5 (0.8–2.9); 5.7 (2.6–12.8); 2.9 (1.5–5.6); 2.7 (1.6–4.6); 2.1 (1.2–3.9)).Conclusions Using machine learning we identified distinct HFpEF phenogroups with differential characteristics and outcomes, as well as differential levels of inflammatory and cardiovascular proteins.