The chronic heart failure evolutions: Different fates and routes.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Agostoni Piergiuseppe, Chiesa Mattia, Salvioni Elisabetta, Emdin Michele, Piepoli Massimo, Sinagra Gianfranco, Senni Michele, Bonomi Alice, Adamopoulos Stamatis, Miliopoulos Dimitris, Mapelli Massimo, Campodonico Jeness, Attanasio Umberto, Apostolo Anna, Pestrin Emanuele, Rossoni Agostino, Magrì Damiano, Paolillo Stefania, Corrà Ugo, Raimondo Rosa, Cittadini Antonio, Iorio Annamaria, Salzano Andrea, Lagioia Rocco, Vignati Carlo, Badagliacca Roberto, Filardi Pasquale Perrone, Correale Michele, Perna Enrico, Metra Marco, Cattadori Gaia, Guazzi Marco, Limongelli Giuseppe, Parati Gianfranco, De Martino Fabiana, Matassini Maria Vittoria, Bandera Francesco, Bussotti Maurizio, Re Federica, Lombardi Carlo M, Scardovi Angela B, Sciomer Susanna, Passantino Andrea, Santolamazza Caterina, Girola Davide, Passino Claudio, Karsten Marlus, Nodari Savina, Pompilio Giulio, MECKI score research group
Аннотация
METHODS AND RESULTS: From a bulk of 7948 HF patients included in the MECKI registry, we selected patients with a minimum 2-year follow-up. We implemented a topological data analysis (TDA), based on 43 variables derived from clinical, biochemical, cardiac ultrasound, and exercise evaluations, to identify several patients' clusters. Thereafter, we used the trajectory analysis to describe the evolution of HF states, which is able to identify bifurcation points, characterized by different follow-up paths, as well as specific end-stages conditions of the disease. Finally, we conducted a 5-year survival analysis (composite of cardiovascular death, left ventricular assist device, or urgent heart transplant). Findings were validated on internal (n = 527) and external (n = 777) populations. We analyzed 4876 patients (age = 63 [53-71], male gender n = 3973 (81.5%), NYHA class I-II n = 3576 (73.3%), III-IV n = 1300 (26.7%), LVEF = 33 [25.5-39.9], atrial fibrillation n = 791 (16.2%), peak VO2% pred = 54.8 [43.8-67.2]), with a minimum 2-year follow-up. Nineteen patient clusters were identified by TDA. Trajectory analysis revealed a path characterized by 3 bifurcation and 4 end-stage points. Clusters survival rate varied from 44% to 100% at 2 years and from 20% to 100% at 5 years, respectively. The event frequency at 5-year follow-up for each study cohort cluster was successfully compared with those in the validation cohorts (R = 0.94 and R = 0.84, P < 0.001, for internal and external cohort, respectively). Finally, we conducted a 5-year survival analysis (composite of cardiovascular death, left ventricular assist device, or urgent heart transplant observed in 22% of cases).
CONCLUSIONS: Each HF phenotype has a specific disease progression and prognosis. These findings allow to individualize HF patient evolutions and to tailor assessment.