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Novel endotypes in heart failure: effects on guideline-directed medical therapy
J Tromp1,2,3, W Ouwerkerk2,4, B G Demissei1
1Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands.
European Heart Journal
|December 15, 2018
Summary
Six heart failure subtypes (endotypes) were identified using biomarker profiles. These endotypes show distinct clinical characteristics, outcomes, and responses to guideline-directed medical therapy, enabling personalized treatment strategies for heart failure (HF) patients.
Area of Science:
- Cardiology
- Biomarker Discovery
- Personalized Medicine
Background:
- Heart failure (HF) is a complex syndrome with diverse patient profiles.
- Identifying distinct patient subgroups (endotypes) is crucial for tailoring treatment and improving outcomes.
Purpose of the Study:
- To determine heart failure (HF) subtypes with distinct clinical profiles and treatment responses.
- To utilize a comprehensive set of biomarkers across various pathophysiological domains for patient stratification.
Main Methods:
- Unsupervised cluster analysis of 92 cardiovascular biomarkers in 1802 patients with HF and reduced ejection fraction (HFrEF).
- Validation of identified endotypes in an independent cohort of 813 patients.
- Assessment of treatment response to guideline-directed medical therapy across identified endotypes.
Main Results:
- Six distinct endotypes of HFrEF were identified based on biomarker profiles.
- Endotype 4 exhibited severe HF symptoms and the highest risk for mortality/hospitalization.
- Differential responses to beta-blocker and ACE-inhibitor/ARB uptitration were observed across endotypes, with some endotypes showing potential harm or benefit.
Conclusions:
- Biomarker-based cluster analysis successfully identified six distinct heart failure endotypes.
- These endotypes possess unique clinical characteristics, prognoses, and differential responses to medical therapy.
- Findings support the potential for precision medicine approaches in managing heart failure based on identified endotypes.
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