Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Institute of Computational Biology, Neuherberg, Germany.
Curr Heart Fail Rep. 2023 Oct;20(5):333-349. doi: 10.1007/s11897-023-00615-z. Epub 2023 Jul 21.
This systematic review aims to summarise clustering studies in heart failure (HF) and guide future clinical trial design and implementation in routine clinical practice.
34 studies were identified (n = 19 in HF with preserved ejection fraction (HFpEF)). There was significant heterogeneity invariables and techniques used. However, 149/165 described clusters could be assigned to one of nine phenotypes: 1) young, low comorbidity burden; 2) metabolic; 3) cardio-renal; 4) atrial fibrillation (AF); 5) elderly female AF; 6) hypertensive-comorbidity; 7) ischaemic-male; 8) valvular disease; and 9) devices. There was room for improvement on important methodological topics for all clustering studies such as external validation and transparency of the modelling process. The large overlap between the phenotypes of the clustering studies shows that clustering is a robust approach for discovering clinically distinct phenotypes. However, future studies should invest in a phenotype model that can be implemented in routine clinical practice and future clinical trial design. HF = heart failure, EF = ejection fraction, HFpEF = heart failure with preserved ejection fraction, HFrEF = heart failure with reduced ejection fraction, CKD = chronic kidney disease, AF = atrial fibrillation, IHD = ischaemic heart disease, CAD = coronary artery disease, ICD = implantable cardioverter-defibrillator, CRT = cardiac resynchronization therapy, NT-proBNP = N-terminal pro b-type natriuretic peptide, BMI = Body Mass Index, COPD = Chronic obstructive pulmonary disease.
综述目的：本系统综述旨在总结心力衰竭（HF）的聚类研究，并为未来常规临床实践中的临床试验设计和实施提供指导。
发现：共确定了 34 项研究（HF 射血分数保留（HFpEF）患者中 19 项）。所用变量和技术存在显著异质性。然而，149/165 个描述的聚类可以归为 9 种表型之一：1）年轻，低合并症负担；2）代谢；3）心肾；4）房颤（AF）；5）老年女性 AF；6）高血压合并症；7）缺血性男性；8）瓣膜疾病；9）器械。所有聚类研究在重要的方法学主题上都有改进的空间，例如外部验证和建模过程的透明度。聚类研究的表型之间存在很大的重叠，这表明聚类是发现临床明显表型的一种稳健方法。然而，未来的研究应该投资于一种可以在常规临床实践和未来临床试验设计中实施的表型模型。HF=心力衰竭，EF=射血分数，HFpEF=心力衰竭射血分数保留，HFrEF=心力衰竭射血分数降低，CKD=慢性肾脏病，AF=房颤，IHD=缺血性心脏病，CAD=冠状动脉疾病，ICD=植入式心脏复律除颤器，CRT=心脏再同步治疗，NT-proBNP=N 末端 pro B 型利钠肽，BMI=体重指数，COPD=慢性阻塞性肺疾病。
