Phenotyping left ventricular systolic dysfunction in asymptomatic individuals for improved risk stratification

Area of Science:

• Cardiology
• Biostatistics
• Medical Imaging

Background:

• Left ventricular systolic dysfunction (LVSD) is a complex condition where prognosis varies significantly.
• Identifying distinct patient subgroups among asymptomatic individuals is crucial for developing targeted preventative strategies.
• Current phenotyping methods may not fully capture the heterogeneity of LVSD.

Purpose of the Study:

• To explore clinical phenotypes of LVSD in asymptomatic individuals using multi-dimensional data clustering.
• To investigate the association between identified LVSD clusters and clinical outcomes, including heart failure development and major adverse cardiovascular events (MACE).
• To evaluate cardiovascular abnormalities associated with different LVSD clinical phenotypes.

Main Methods:

• Clustering analysis was applied to 60 clinical variables from 1563 UK Biobank participants with reduced left ventricular ejection fraction (LVEF < 50%) but no prior heart failure.
• The study assessed risks for heart failure, cardiovascular events, death, and MACE across identified clusters.
• Cardiovascular imaging characteristics were evaluated separately from the clustering variables.

Main Results:

• Three distinct clinical clusters of LVSD were identified, showing significant differences in lifestyle, risk factors, ECG parameters, and cardiometabolic profiles.
• A progressive increase in risk was observed from Cluster 1 to Cluster 3, independent of traditional risk factors and LVEF.
• Cluster 3, the highest-risk group, exhibited adverse cardiovascular imaging findings, including greater LV remodeling and myocardial dysfunction, with a significantly higher MACE risk (1.72 times) compared to Cluster 1.

Conclusions:

• Multi-dimensional clustering of clinical data successfully identified three distinct risk profiles and clinical trajectories for LVSD in asymptomatic individuals.
• These identified LVSD subtypes offer opportunities for improved characterization.
• Tailored interventions based on specific LVSD subtypes could potentially improve clinical outcomes.