Phenotype-Specific Outcome and Treatment Response in Heart Failure with Preserved Ejection Fraction with Comorbid Hypertension and Diabetes: A 12-Month Multicentered Prospective Cohort Study
Despite evidence of SGLT2 inhibitors in improving cardiovascular outcomes of heart failure with preserved ejection fraction (HFpEF), the heterogenous mechanism and characteristic multimorbidity of HFpEF require a phenotypic approach. Metabolic phenotype, one common HFpEF phenotype, has various prese...
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MDPI AG
2023-07-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/13/8/1218 |
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| author | Ngoc-Thanh-Van Nguyen Hoai-An Nguyen Hai Hoang Nguyen Binh Quang Truong Hoa Ngoc Chau |
| author_facet | Ngoc-Thanh-Van Nguyen Hoai-An Nguyen Hai Hoang Nguyen Binh Quang Truong Hoa Ngoc Chau |
| author_sort | Ngoc-Thanh-Van Nguyen |
| collection | DOAJ |
| description | Despite evidence of SGLT2 inhibitors in improving cardiovascular outcomes of heart failure with preserved ejection fraction (HFpEF), the heterogenous mechanism and characteristic multimorbidity of HFpEF require a phenotypic approach. Metabolic phenotype, one common HFpEF phenotype, has various presentations and prognoses worldwide. We aimed to identify different phenotypes of hypertensive-diabetic HFpEF, their phenotype-related outcomes, and treatment responses. The primary endpoint was time to the first event of all-cause mortality or hospitalization for heart failure (HHF). Among 233 recruited patients, 24.9% experienced primary outcomes within 12 months. A total of 3.9% was lost to follow-up. Three phenotypes were identified. Phenotype 1 (n = 126) consisted of lean, elderly females with chronic kidney disease, anemia, and concentric hypertrophy. Phenotype 2 (n = 62) included younger males with coronary artery disease. Phenotype 3 (n = 45) comprised of obese elderly with atrial fibrillation. Phenotype 1 and 2 reported higher primary outcomes than phenotype 3 (<i>p</i> = 0.002). Regarding treatment responses, SGLT2 inhibitor was associated with fewer primary endpoints in phenotype 1 (<i>p</i> = 0.003) and 2 (<i>p</i> = 0.001). RAAS inhibitor was associated with fewer all-cause mortality in phenotype 1 (<i>p</i> = 0.003). Beta blocker was associated with fewer all-cause mortality in phenotype 1 (<i>p</i> = 0.024) and fewer HHF in phenotype 2 (<i>p</i> = 0.011). Our pioneering study supports the personalized approach to optimize HFpEF management in hypertensive-diabetic patients. |
| first_indexed | 2024-03-10T23:49:06Z |
| format | Article |
| id | doaj.art-fd1b38cfd9ee462bbe6187b411127626 |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-10T23:49:06Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-fd1b38cfd9ee462bbe6187b4111276262023-11-19T01:48:44ZengMDPI AGJournal of Personalized Medicine2075-44262023-07-01138121810.3390/jpm13081218Phenotype-Specific Outcome and Treatment Response in Heart Failure with Preserved Ejection Fraction with Comorbid Hypertension and Diabetes: A 12-Month Multicentered Prospective Cohort StudyNgoc-Thanh-Van Nguyen0Hoai-An Nguyen1Hai Hoang Nguyen2Binh Quang Truong3Hoa Ngoc Chau4Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, VietnamCentral Clinical School, Monash University, Melbourne, VIC 3004, AustraliaCardiovascular Department, Nhan Dan Gia Dinh Hospital, Ho Chi Minh City 700000, VietnamDepartment of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, VietnamDepartment of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, VietnamDespite evidence of SGLT2 inhibitors in improving cardiovascular outcomes of heart failure with preserved ejection fraction (HFpEF), the heterogenous mechanism and characteristic multimorbidity of HFpEF require a phenotypic approach. Metabolic phenotype, one common HFpEF phenotype, has various presentations and prognoses worldwide. We aimed to identify different phenotypes of hypertensive-diabetic HFpEF, their phenotype-related outcomes, and treatment responses. The primary endpoint was time to the first event of all-cause mortality or hospitalization for heart failure (HHF). Among 233 recruited patients, 24.9% experienced primary outcomes within 12 months. A total of 3.9% was lost to follow-up. Three phenotypes were identified. Phenotype 1 (n = 126) consisted of lean, elderly females with chronic kidney disease, anemia, and concentric hypertrophy. Phenotype 2 (n = 62) included younger males with coronary artery disease. Phenotype 3 (n = 45) comprised of obese elderly with atrial fibrillation. Phenotype 1 and 2 reported higher primary outcomes than phenotype 3 (<i>p</i> = 0.002). Regarding treatment responses, SGLT2 inhibitor was associated with fewer primary endpoints in phenotype 1 (<i>p</i> = 0.003) and 2 (<i>p</i> = 0.001). RAAS inhibitor was associated with fewer all-cause mortality in phenotype 1 (<i>p</i> = 0.003). Beta blocker was associated with fewer all-cause mortality in phenotype 1 (<i>p</i> = 0.024) and fewer HHF in phenotype 2 (<i>p</i> = 0.011). Our pioneering study supports the personalized approach to optimize HFpEF management in hypertensive-diabetic patients.https://www.mdpi.com/2075-4426/13/8/1218heart failure with preserved ejection fractionhypertensiondiabetesphenotypepersonalized approachall-cause mortality |
| spellingShingle | Ngoc-Thanh-Van Nguyen Hoai-An Nguyen Hai Hoang Nguyen Binh Quang Truong Hoa Ngoc Chau Phenotype-Specific Outcome and Treatment Response in Heart Failure with Preserved Ejection Fraction with Comorbid Hypertension and Diabetes: A 12-Month Multicentered Prospective Cohort Study Journal of Personalized Medicine heart failure with preserved ejection fraction hypertension diabetes phenotype personalized approach all-cause mortality |
| title | Phenotype-Specific Outcome and Treatment Response in Heart Failure with Preserved Ejection Fraction with Comorbid Hypertension and Diabetes: A 12-Month Multicentered Prospective Cohort Study |
| title_full | Phenotype-Specific Outcome and Treatment Response in Heart Failure with Preserved Ejection Fraction with Comorbid Hypertension and Diabetes: A 12-Month Multicentered Prospective Cohort Study |
| title_fullStr | Phenotype-Specific Outcome and Treatment Response in Heart Failure with Preserved Ejection Fraction with Comorbid Hypertension and Diabetes: A 12-Month Multicentered Prospective Cohort Study |
| title_full_unstemmed | Phenotype-Specific Outcome and Treatment Response in Heart Failure with Preserved Ejection Fraction with Comorbid Hypertension and Diabetes: A 12-Month Multicentered Prospective Cohort Study |
| title_short | Phenotype-Specific Outcome and Treatment Response in Heart Failure with Preserved Ejection Fraction with Comorbid Hypertension and Diabetes: A 12-Month Multicentered Prospective Cohort Study |
| title_sort | phenotype specific outcome and treatment response in heart failure with preserved ejection fraction with comorbid hypertension and diabetes a 12 month multicentered prospective cohort study |
| topic | heart failure with preserved ejection fraction hypertension diabetes phenotype personalized approach all-cause mortality |
| url | https://www.mdpi.com/2075-4426/13/8/1218 |
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