Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.
ESC Heart Fail. 2022 Aug;9(4):2567-2575. doi: 10.1002/ehf2.13969. Epub 2022 May 19.
The aims of this study were to explore phenotypes of heart failure with preserved ejection fraction (HFpEF) and evaluate differential effects of spironolactone treatment.
A swap-stepwise algorithm was used for variable selection. Latent class analysis based on 10 selected variables was employed in a derivative set of 1540 patients from the TOPCAT trial. Cox proportional hazard models were used to evaluate the prognoses and effects of spironolactone treatment. Three phenotypes of HFpEF were identified. Phenotype 1 was the youngest with low burden of co-morbidities. Phenotype 2 was the oldest with high prevalence of atrial fibrillation, pacemaker implantation, and hypothyroidism. Phenotype 3 was mostly obese and diabetic with high burden of other co-morbidities. Compared with phenotype 1, phenotypes 2 (hazard ratio [HR]: 1.46; 95% confidence interval [CI]: 1.14-1.89; P = 0.003) and 3 (HR: 2.35; 95% CI: 1.80-3.07; P < 0.001) were associated with higher risks of the primary composite outcome. Spironolactone treatment was associated with a reduced risk of the primary outcome only in phenotype 1 (HR: 0.63; 95% CI: 0.40-0.98; P = 0.042).
Three distinct HFpEF phenotypes were identified. Spironolactone treatment could improve clinical outcome in a phenotype of relatively young patients with low burden of co-morbidities.
本研究旨在探讨射血分数保留的心力衰竭（HFpEF）的表型，并评估螺内酯治疗的差异影响。
采用交换逐步算法进行变量选择。基于 10 个选定变量的潜在类别分析应用于 TOPCAT 试验的 1540 例患者的衍生组。Cox 比例风险模型用于评估预后和螺内酯治疗的效果。确定了 HFpEF 的三种表型。表型 1 是最年轻的，合并症负担较低。表型 2 是最年长的，心房颤动、起搏器植入和甲状腺功能减退症的患病率较高。表型 3 主要肥胖且患有糖尿病，其他合并症负担较高。与表型 1 相比，表型 2（风险比[HR]：1.46；95%置信区间[CI]：1.14-1.89；P=0.003）和表型 3（HR：2.35；95%CI：1.80-3.07；P<0.001）与主要复合结局的较高风险相关。螺内酯治疗仅与表型 1 （HR：0.63；95%CI：0.40-0.98；P=0.042）的主要结局风险降低相关。
确定了三种不同的 HFpEF 表型。螺内酯治疗可改善低合并症负担的相对年轻患者的表型的临床结局。
