Open AccessPhenomapping in patients experiencing worsening renal function during hospitalization for acute heart failure
Author(s) -
Yagi Ryuichiro,
Takei Makoto,
Kohsaka Shun,
Shiraishi Yasuyuki,
Ikemura Nobuhiro,
Shoji Satoshi,
Niimi Nozomi,
Higuchi Satoshi,
Goda Ayumi,
Kohno Takashi,
Nagatomo Yuji,
Nishihata Yosuke,
Sujino Yasumori,
Saji Mike,
Ikegami Yukinori,
Nakano Shintaro,
Takahashi Toshiyuki,
Fukuda Keiichi,
Yoshikawa Tsutomu
Publication year - 2021
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.13598
Subject(s) - heart failure , medicine , ejection fraction , propensity score matching , renal function , cardiology , incidence (geometry) , clinical endpoint , weather research and forecasting model , randomized controlled trial , physics , optics , meteorology
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 m 2 ), 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 m 2 ), 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.