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Identification of phenotypes in heart failure with preserved ejection fraction among 8161 patients from 3 Spanish
Òscar Miró1, Olivier Peyrony2, Joan Carles Trullàs3
1Servicio de Urgencias, Hospital Clínic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain.
Insights
This study identified four heart failure with preserved ejection fraction (HFpEF) phenotypes, revealing significant differences in mortality risk. Renin-angiotensin system inhibitors offered a survival benefit across all HFpEF phenotypes.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome with heterogeneous clinical presentations.
- Understanding HFpEF phenotypes is crucial for tailoring treatment strategies and improving patient outcomes.
Purpose of the Study:
- To identify distinct phenotypes within the HFpEF population.
- To compare the 1-year mortality rates among these identified phenotypes.
- To investigate the differential effects of common HFpEF treatments across the identified phenotypes.
Main Methods:
- Secondary analysis of 8161 HFpEF patients from three Spanish registries (INCLIVA, RICA, EAHFE).
- Latent class analysis used to identify phenotypic clusters based on 16 baseline characteristics.
- Crude and treatment-adjusted 1-year survival rates were analyzed, including treatment-phenotype interactions.
Main Results:
- Four distinct HFpEF phenotypes were identified, with 1-year mortality rates varying significantly.
- Cluster 1 (male phenotype with cardiomyopathy) exhibited the highest mortality (24.0%), while Cluster 4 (younger women with valvular heart disease) had the lowest (13.7%).
- Renin-angiotensin system inhibitors showed a survival benefit across all clusters; beta-blockers were beneficial in Cluster 1, and anticoagulants in Cluster 4, but no treatment demonstrated a phenotype-specific effect.
Conclusions:
- The study successfully defined four HFpEF phenotypes with markedly different prognoses.
- Renin-angiotensin system inhibitors appear to be the only treatment with a generalized survival benefit in HFpEF.
- No analyzed treatment demonstrated a differential impact on prognosis based on the identified HFpEF phenotype.
Introduction And Objectives:
To identify phenotypes in heart failure with preserved ejection fraction (HFpEF), compare mortality, and investigate whether treatments have different effects according to phenotype.
Methods:
We performed a secondary analysis of 8161 patients with HFpEF included in Spanish cardiology (INCLIVA), internal medicine (RICA), and emergency (EAHFE) registries. Phenotypic clusters based on 16 baseline characteristics were identified using latent class analysis. We analyzed crude and treatment-adjusted 1-year survival, the associations between each treatment and mortality, and their interactions with phenotype.
Results:
We identified 4 distinct clusters. One-year mortality was 18.7%. Cluster 4 (younger women with a valvular heart disease phenotype) had the lowest mortality (13.7%; reference category), which increased progressively in cluster 2 (cardiometabolic phenotype; mortality: 15.7%; adjusted HR, 1.28; 95%CI, 1.06-1.54), cluster 3 (very elderly female phenotype; mortality: 20.4%; adjusted HR, 1.63; 95%CI, 1.40-1.90), and cluster 1 (male phenotype with cardiomyopathy; mortality: 24.0%; adjusted HR, 1.81; 95%CI, 1.53-2.13). The results were very similar when each registry was analyzed individually. Treatment with renin-angiotensin system inhibitors was associated with better survival in all clusters, beta-blockers were beneficial in cluster 1, and anticoagulants in cluster 4. However, none of the treatments show ed a differential association with prognosis according to phenotype.
Conclusions:
This study defines 4 HFpEF phenotypes with significantly different prognoses. Among the treatments analyzed, only renin-angiotensin system inhibitors seemed to have a generalized survival benefit, and none demonstrated a differential effect based on phenotype.
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