Rakesh K Mishra1, Geoffrey H Tison2, Qizhi Fang1, Rebecca Scherzer3, Mary A Whooley3, Nelson B Schiller4. 1. Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California. 2. Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California. Electronic address: geoff.tison@ucsf.edu. 3. Department of Medicine, San Francisco Veterans' Affairs Medical Center, San Francisco, California. 4. Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California; Department of Medicine, San Francisco Veterans' Affairs Medical Center, San Francisco, California.
Abstract
BACKGROUND: Many individual echocardiographic variables have been associated with heart failure (HF) in patients with stable coronary artery disease (CAD), but their combined utility for prediction has not been well studied. METHODS: Unsupervised model-based cluster analysis was performed by researchers blinded to the study outcome in 1,000 patients with stable CAD on 15 transthoracic echocardiographic variables. We evaluated associations of cluster membership with HF hospitalization using Cox proportional hazards regression analysis. RESULTS: The echo-derived clusters partitioned subjects into four phenogroupings: phenogroup 1 (n = 85) had the highest levels, phenogroups 2 (n = 314) and 3 (n = 205) displayed intermediate levels, and phenogroup 4 (n = 396) had the lowest levels of cardiopulmonary structural and functional abnormalities. Over 7.1 ± 3.2 years of follow-up, there were 198 HF hospitalizations. After multivariable adjustment for traditional cardiovascular risk factors, phenogroup 1 was associated with a nearly fivefold increased risk (hazard ratio [HR] = 4.8; 95% CI, 2.4-9.5), phenogroup 2 was associated with a nearly threefold increased risk (HR = 2.7; 95% CI, 1.4-5.0), and phenogroup 3 was associated with a nearly twofold increased risk (HR = 1.9; 95% CI, 1.0-3.8) of HF hospitalization, relative to phenogroup 4. CONCLUSIONS: Transthoracic echocardiographic variables can be used to classify stable CAD patients into separate phenogroupings that differentiate cardiopulmonary structural and functional abnormalities and can predict HF hospitalization, independent of traditional cardiovascular risk factors.
BACKGROUND: Many individual echocardiographic variables have been associated with heart failure (HF) in patients with stable coronary artery disease (CAD), but their combined utility for prediction has not been well studied. METHODS: Unsupervised model-based cluster analysis was performed by researchers blinded to the study outcome in 1,000 patients with stable CAD on 15 transthoracic echocardiographic variables. We evaluated associations of cluster membership with HF hospitalization using Cox proportional hazards regression analysis. RESULTS: The echo-derived clusters partitioned subjects into four phenogroupings: phenogroup 1 (n = 85) had the highest levels, phenogroups 2 (n = 314) and 3 (n = 205) displayed intermediate levels, and phenogroup 4 (n = 396) had the lowest levels of cardiopulmonary structural and functional abnormalities. Over 7.1 ± 3.2 years of follow-up, there were 198 HF hospitalizations. After multivariable adjustment for traditional cardiovascular risk factors, phenogroup 1 was associated with a nearly fivefold increased risk (hazard ratio [HR] = 4.8; 95% CI, 2.4-9.5), phenogroup 2 was associated with a nearly threefold increased risk (HR = 2.7; 95% CI, 1.4-5.0), and phenogroup 3 was associated with a nearly twofold increased risk (HR = 1.9; 95% CI, 1.0-3.8) of HF hospitalization, relative to phenogroup 4. CONCLUSIONS: Transthoracic echocardiographic variables can be used to classify stable CADpatients into separate phenogroupings that differentiate cardiopulmonary structural and functional abnormalities and can predict HF hospitalization, independent of traditional cardiovascular risk factors.
Authors: Roberto M Lang; Luigi P Badano; Victor Mor-Avi; Jonathan Afilalo; Anderson Armstrong; Laura Ernande; Frank A Flachskampf; Elyse Foster; Steven A Goldstein; Tatiana Kuznetsova; Patrizio Lancellotti; Denisa Muraru; Michael H Picard; Ernst R Rietzschel; Lawrence Rudski; Kirk T Spencer; Wendy Tsang; Jens-Uwe Voigt Journal: J Am Soc Echocardiogr Date: 2015-01 Impact factor: 5.251
Authors: N B Schiller; C G Skiôldebrand; E J Schiller; C C Mavroudis; N H Silverman; S H Rahimtoola; M J Lipton Journal: Circulation Date: 1983-07 Impact factor: 29.690
Authors: Bernice Ruo; John S Rumsfeld; Mark A Hlatky; Haiying Liu; Warren S Browner; Mary A Whooley Journal: JAMA Date: 2003-07-09 Impact factor: 56.272