Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson, Rohan; Jaiswal, Abhishek; Ennezat, Pierre Vladimir; Cassidy, Mark M.; Jemtel, Thierry H. Le

doi:10.1161/jaha.115.002477

Cited by 109 publications

(107 citation statements)

References 322 publications

(494 reference statements)

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“…These observations could reflect regional differences in management of chronic HF and HF risk factors, as well as perioperative management of patients with HF. The HFpEF comorbidities found in the present study (ie, older age, female sex, frailty, hypertension, absence of previous MI, diabetes mellitus, and obesity) were consistent with previous studies 5, 33…”

Section: Discussionsupporting

confidence: 92%

Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction

Sun

Eddeen

2018

JAHA

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BackgroundHeart failure (HF) with reduced ejection fraction (rEF) is a widely regarded prognosticator after coronary artery bypass grafting. HF with preserved ejection fraction (pEF) accounts for up to half of all HF cases and is associated with considerable morbidity and mortality in hospitalized cohorts. However, HFpEF outcomes have not been elucidated in cardiac surgical patients. We investigated the prevalence and outcomes of HFpEF and HFrEF in women and men following coronary artery bypass grafting.Methods and ResultsWe conducted a retrospective cohort study in Ontario, Canada, between October 1, 2008, and March 31, 2015, using Cardiac Care Network and Canadian Institute of Health Information data. HF is captured through a validated population‐based database of all Ontarians with physician‐diagnosed HF. We defined pEF as ejection fraction ≥50% and rEF as ejection fraction <50%. The primary outcome was all‐cause mortality. Analyses were stratified by sex. Mortality rates were calculated using Kaplan–Meier method. The relative hazard of death was assessed using multivariable Cox proportional hazard models. Of 40 083 patients (20.6% women), 55.5% had pEF without HF, 25.7% had rEF without HF, 6.9% had HFpEF, and 12.0% had HFrEF. Age‐standardized HFpEF mortality rates at 4±2 years of follow‐up were similar in women and men. HFrEF standardized HFpEF mortality rates were higher in women than men.ConclusionsWe found a higher prevalence and poorer prognosis of HFpEF in women. A history of HF was a more important prognosticator than ejection fraction. Preoperative screening and extended postoperative follow‐up should be focused on women and men with HF rather than on rEF alone.

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Section: Discussionsupporting

confidence: 92%

Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction

Sun

Eddeen

2018

JAHA

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“…8 This trend toward increased rates of HFpEF with increasing age was supported in other studies, including one that demonstrated that up to 59% of all patients >85 years had HFpEF. 9,10 Annual mortality ranges from 10% to 30%, with nearly 60% of HFpEF patients dying from cardiovascular causes. 7 However, noncardiovascular deaths constitute a higher proportion of cause of death in HFpEF compared with HFrEF.…”

Section: Prevalence and Incidence Of Hfpefmentioning

confidence: 99%

“…9 The cause of HFpEF is multifactorial, but the consistent underlying aspects are similar: a proinflammatory state perpetuated by one or more of several disease states leads to inflammation within the coronary microvasculature and its endothelium. Endothelial dysfunction leads to reductions in available nitric oxide and activity of protein kinase G (PKG).…”

Section: Pathophysiology Of Hfpefmentioning

confidence: 99%

Heart Failure With Preserved Ejection Fraction: A Perioperative Review

Shillcutt

Chacon

Brakke

et al. 2017

Journal of Cardiothoracic and Vascular Anesthesia

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“…Patients in these groups tend to have different demographics, co-morbidities, and responses to therapy. Several large, randomized controlled trials in patients with HFrEF have shown therapeutic benefit for a range of neurohormonal medications and intracardiac devices; however, large clinical trials have not demonstrated similar clinical benefit in patients with HFpEF 2,3 . The heterogeneity in the pathogenesis and in the clinical phenotypes of HFpEF may have contributed to lack of large, positive clinical trials 4 .…”

Section: Introductionmentioning

confidence: 99%

“…The combination of older age and these comorbidities may contribute to the systemic inflammation that in turn affects multiple signaling cascades and organ systems, including the heart, lungs, skeletal muscles, and kidneys 4 . The culmination of these pathways leads to different manifestations of the clinical syndrome of HFpEF, including unique combinations of co-morbidities, changes in cardiac remodeling and mechanics, biomarker profiles, and clinical symptoms 3,4,6 . Understanding these combinations may be informative to the design of future trials testing targeted therapeutic approaches.…”

Section: Introductionmentioning

confidence: 99%

Tensor Factorization for Precision Medicine in Heart Failure with Preserved Ejection Fraction

Luo

Ahmad

Shah

2017

J. of Cardiovasc. Trans. Res.

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Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome that may benefit from improved subtyping in order to better characterize its pathophysiology and to develop novel targeted therapies. The United States Precision Medicine Initiative comes amid the rapid growth in quantity and modality of clinical data for HFpEF patients ranging from deep phenotypic to trans-omic data. Tensor factorization, a form of machine learning, allows for the integration of multiple data modalities to derive clinically relevant HFpEF subtypes that may have significant differences in underlying pathophysiology and differential response to therapies. Tensor factorization also allows for better interpretability by supporting dimensionality reduction and identifying latent groups of data for meaningful summarization of both features and disease outcomes. In this narrative review, we analyze the modest literature on the application of tensor factorization to related biomedical fields including genotyping and phenotyping. Based on the cited work including work of our own, we suggest multiple tensor factorization formulations capable of integrating the deep phenotypic and trans-omic modalities of data for HFpEF, or accounting for interactions between genetic variants at different -omic hierarchies. We encourage extensive experimental studies to tackle challenges in applying tensor factorization for precision medicine in HFpEF, including effectively incorporating existing medical knowledge, properly accounting for uncertainty, and efficiently enforcing sparsity for better interpretability.

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Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Cited by 109 publications

References 322 publications

Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction

Prevalence and Long‐Term Survival After Coronary Artery Bypass Grafting in Women and Men With Heart Failure and Preserved Versus Reduced Ejection Fraction

Heart Failure With Preserved Ejection Fraction: A Perioperative Review

Tensor Factorization for Precision Medicine in Heart Failure with Preserved Ejection Fraction

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