Institut Cardiovasculaire Paris Sud, Cardiovascular Magnetic Resonance Laboratory, Hôpital Privé Jacques Cartier, Ramsay Santé, 91300 Massy, France; Department of Cardiology, Lariboisière Hospital, AP-HP, Inserm UMRS 942, University of Paris, 75010 Paris, France.
Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, 33600 Pessac, France.
Arch Cardiovasc Dis. 2022 Dec;115(12):627-636. doi: 10.1016/j.acvd.2022.08.004. Epub 2022 Oct 24.
Inconclusive non-invasive stress testing is associated with impaired outcome. This population is very heterogeneous, and its characteristics are not well depicted by conventional methods.
To identify patient subgroups by phenotypic unsupervised clustering, integrating clinical and cardiovascular magnetic resonance data to unveil pathophysiological differences between subgroups of patients with inconclusive stress tests.
Between 2008 and 2020, consecutive patients with a first inconclusive non-invasive stress test referred for stress cardiovascular magnetic resonance were followed for the occurrence of major adverse cardiovascular events (defined as cardiovascular death or myocardial infarction). A cluster analysis was performed on clinical and cardiovascular magnetic resonance variables.
Of 1402 patients (67% male; mean age 70±11years) who completed the follow-up (median 6.5years, interquartile range 5.6-7.5years), 197 experienced major adverse cardiovascular events (14.1%). Three distinct phenogroups were identified based upon unsupervised hierarchical clustering of principal components: phenogroup 1=history of percutaneous coronary intervention with viable myocardial infarction and preserved left ventricular ejection fraction; phenogroup 2=atrial fibrillation with preserved left ventricular ejection fraction; and phenogroup 3=coronary artery bypass graft with non-viable myocardial scar and reduced left ventricular ejection fraction. Using survival analysis, the occurrence of major adverse cardiovascular events (P=0.007), cardiovascular mortality (P=0.002) and all-cause mortality (P<0.001) differed among the three phenogroups. Phenogroup 3 presented the worse prognosis. In each phenogroup, ischaemia was associated with major adverse cardiovascular events (phenogroup 1: hazard ratio 2.79, 95% confidence interval 1.61-4.84; phenogroup 2: hazard ratio 2.59, 95% confidence interval 1.69-3.97; phenogroup 3: hazard ratio 3.16, 95% confidence interval 1.82-5.49; all P<0.001).
Cluster analysis of clinical and cardiovascular magnetic resonance variables identified three phenogroups of patients with inconclusive stress testing, with distinct prognostic profiles.
不确定的非侵入性应激测试与不良预后相关。该人群非常多样化，传统方法无法很好地描述其特征。
通过表型无监督聚类来确定患者亚组，整合临床和心血管磁共振数据，揭示不确定应激测试患者亚组之间的病理生理差异。
在 2008 年至 2020 年间，连续对因首次不确定的非侵入性应激测试而转介进行应激心血管磁共振的患者进行了随访，以观察主要不良心血管事件（定义为心血管死亡或心肌梗死）的发生情况。对临床和心血管磁共振变量进行聚类分析。
在完成随访的 1402 例患者（67%为男性；平均年龄 70±11 岁）中，197 例发生主要不良心血管事件（14.1%）。基于主成分的无监督层次聚类，确定了三个不同的表型组：表型组 1=经皮冠状动脉介入治疗伴存活心肌梗死和保留左心室射血分数；表型组 2=心房颤动伴保留左心室射血分数；表型组 3=冠状动脉旁路移植术伴非存活心肌瘢痕和左心室射血分数降低。通过生存分析，三个表型组之间主要不良心血管事件的发生（P=0.007）、心血管死亡率（P=0.002）和全因死亡率（P<0.001）存在差异。表型组 3 预后最差。在每个表型组中，缺血与主要不良心血管事件相关（表型组 1：危险比 2.79，95%置信区间 1.61-4.84；表型组 2：危险比 2.59，95%置信区间 1.69-3.97；表型组 3：危险比 3.16，95%置信区间 1.82-5.49；均 P<0.001）。
对临床和心血管磁共振变量进行聚类分析，确定了不确定应激测试患者的三个表型组，具有不同的预后特征。
