Phenomapping in patients experiencing worsening renal function during hospitalization for acute heart failure

ESC Heart Failure

Nozomi Niimi¹  Satoshi Shoji¹  Keiichi Fukuda¹  Yasuyuki Shiraishi¹  Nobuhiro Ikemura¹  Shun Kohsaka¹  Yuji Nagatomo²  Yukinori Ikegami²  Ryuichiro Yagi³  Makoto Takei³  Toshiyuki Takahashi³  Yasumori Sujino⁴  Shintaro Nakano⁴  Tsutomu Yoshikawa⁵  Mike Saji⁵  Yosuke Nishihata⁶  Ayumi Goda⁷  Satoshi Higuchi⁷  Takashi Kohno⁷ 

[1] Department of Cardiology Keio University School of Medicine Shinanomachi 35, Shinjuku‐ku Tokyo 160‐8582 Japan;Department of Cardiology National Defense Medical College Tokorozawa Japan;Department of Cardiology Saiseikai Central Hospital Tokyo Japan;Department of Cardiology Saitama Medical University, International Medical Center Saitama Japan;Department of Cardiology Sakakibara Heart Institute Tokyo Japan;Department of Cardiology St. Luke's International Hospital Tokyo Japan;Department of Cardiovascular Medicine Kyorin University Faculty of Medicine Tokyo Japan;

关键词: Acute heart failure;    Diuretics;    Worsening renal function;    Cardiorenal syndrome;    Cluster analysis;   

DOI  :  10.1002/ehf2.13598

来源: DOAJ

【 摘 要 】

Abstract Aims The impact of worsening renal function (WRF) on the prognosis of patients with acute heart failure (AHF) remains controversial. We aimed to identify phenotypically distinct subgroups among individuals with both AHF and WRF using cluster analysis. Methods and results Overall, the data of 483 patients with both AHF and WRF enrolled in the West Tokyo Heart Failure Registry were analysed. Using cluster analysis, we identified three phenotypically distinct subgroups (phenogroups 1, 2, and 3). We assessed the impact of WRF on the prognosis of each phenogroup by comparing the incidence of composite endpoints, including all‐cause death and re‐hospitalization due to heart failure, with those of a propensity score‐matched, non‐WRF control group. Participants in phenogroup 1 (N = 122) were the youngest (69.3 ± 13.7 years), had relatively preserved estimated glomerular filtration rate (eGFR, 70.0 ± 27.7 mL/min/1.73 m2), and reduced left ventricular ejection fraction (LVEF) (41.8 ± 13.7%). Conversely, participants in phenogroup 3 (N = 122) were the oldest (81.7 ± 8.5 years), had the worst eGFR (33.0 ± 20.9 mL/min/1.73 m2), and had preserved LVEF (51.7 ± 14.8%). The characteristics of the participants in phenogroup 2 (N = 239) were between those of phenogroups 1 and 3. The propensity score matching analysis showed that WRF was associated with a higher incidence of composite endpoints in phenogroup 1, whereas this association was not observed in phenogroups 2 and 3. Conclusions Using cluster analysis, we revealed three phenotypically distinct subgroups of patients with both AHF and WRF. WRF was associated with worse clinical outcomes in the subgroup of younger patients with reduced LVEF and preserved renal function.

【 授权许可】

Unknown