Differences in Repolarization Heterogeneity Among Heart Failure With Preserved Ejection Fraction Phenotypic Subgroups
Differences in Repolarization Heterogeneity Among Heart Failure With Preserved Ejection Fraction Phenotypic Subgroups
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DOI：
10.1016/j.amjcard.2017.05.031
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发表时间：
2017-08-15
影响因子：
2.8
通讯作者：
Sauer, Andrew J.
中科院分区：
文献类型：
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作者：
Oskouie, Suzanne K.;Prenner, Stuart B.;Sauer, Andrew J.
射血分数保留的心力衰竭（HFpEF）是一种高度异质性综合征，与多种医学合并症和病理生理学途径或表型相关。我们最近开发了一种将深度表型分析与机器学习分析相结合的表型图谱方法，将 HFpEF 患者分为 3 个临床不同的表型亚组（表型组），具有不同的临床结果。表组#1 更年轻，B 型利尿钠肽水平较低；表组#2 肥胖和糖尿病患病率最高；表组#3 年龄最老，慢性肾病因素最多，心肌力学功能失调最严重，不良后果也最高。然而，这些表型组之间的病理生理学差异仍未得到完整描述。我们试图评估这 3 组在复极异质性方面是否存在差异，此前已将复极异质性与 HFpEF 的不良后果联系起来。 T 峰到 T 端 (TpTe) 间隔是一种经过充分验证的复极异质性指标，由 2 名互不知情的读者测量，并测量了参加系统观察研究的 201 名 HFpEF 患者心电图的所有其他临床数据。 TpTe 持续时间与较高的 B 型利钠肽水平 (p = 0.006)、QRS-T 角增加 (p = 0.008) 和较低的隔膜 e' 速度 (p = 0.007) 相关。与表组 #1 (91.2 +/- 17.3 ms) 和 #2 (90.2 +/- 17.0 ms) 相比，表组 #3 的 TpTe 持续时间最长 (100.4 +/- 24.5 ms) (p = 0.0098)。在多变量分析中，TpTe 增加与高风险表型组#3 分类独立相关。总之，复极异质性是使用无监督机器学习分析确定的 HFpEF 患者特定子集的标志，因此可能是该 HFpEF 患者子集的关键病理生理标志。 (C) 2017 Elsevier Inc. 保留所有权利。
Heart failure with preserved ejection fraction (HFpEF) is a highly heterogeneous syndrome associated with multiple medical comorbidities and pathophysiologic pathways or phenotypes. We recently developed a phenomapping method combining deep phenotyping with machine learning analysis to classify HFpEF patients into 3 clinically distinct phenotypic subgroups (phenogroups) with different clinical outcomes. Phenogroup #1 was younger with lower B-type natriuretic peptide levels, phenogroup #2 had the highest prevalence of obesity and diabetes mellitus, and phenogroup #3 was the oldest with the most factors for chronic kidney disease, the most dysfunctional myocardial mechanics, and the highest adverse outcomes. The pathophysiological differences between these phenogroups, however, remain incompletely described. We sought to evaluate whether these 3 groups differ on the basis of repolarization heterogeneity, which has previously been linked to adverse outcomes in HFpEF. The T-peak to T-end (TpTe) interval, a well-validated index of repolarization heterogeneity, was measured by 2 readers blinded to each other and all other clinical data on the electrocardiograms of 201 HFpEF patients enrolled in a systematic observational study. TpTe duration was associated with higher B-type natriuretic peptide level (p = 0.006), increased QRS-T angle (p = 0.008), and lower septal e' velocity (p = 0.007). TpTe duration was greatest in phenogroup #3 (100.4 +/- 24.5 ms) compared with phenogroups #1 (91.2 +/- 17.3 ms) and #2 (90.2 +/- 17.0 ms) (p = 0.0098). On multivariable analyses, increased TpTe was independently associated with the high-risk phenogroup #3 classification. In conclusion, repolarization heterogeneity is a marker of a specific subset of HFpEF patients identified using unsupervised machine learning analysis and therefore may be a key pathophysiologic marker in this subset of HFpEF patients. (C) 2017 Elsevier Inc. All rights reserved.