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

Elisa Rauseo1,2, Musa Abdulkareem1,2,3, Abbas Khan4,5

  • 1William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK.

European Heart Journal. Cardiovascular Imaging
|September 12, 2023
PubMed

Insights

Three patient clusters with left ventricular systolic dysfunction (LVSD) were identified. These distinct groups show varying risks for major adverse cardiovascular events (MACE), guiding personalized preventative strategies.

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.
Abstract

Keywords:
cardiovascular eventscardiovascular magnetic resonanceheart failureleft ventricular systolic dysfunctionprognosisrisk stratification

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