The chronic heart failure evolutions: Different fates and routes
Abstract Aims Individual prognostic assessment and disease evolution pathways are undefined in chronic heart failure (HF). The application of unsupervised learning methodologies could help to identify patient phenotypes and the progression in each phenotype as well as to assess adverse event risk. M...
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2025-02-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.14966 |
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| author | Piergiuseppe Agostoni Mattia Chiesa Elisabetta Salvioni Michele Emdin Massimo Piepoli Gianfranco Sinagra Michele Senni Alice Bonomi Stamatis Adamopoulos Dimitris Miliopoulos Massimo Mapelli Jeness Campodonico Umberto Attanasio Anna Apostolo Emanuele Pestrin Agostino Rossoni Damiano Magrì Stefania Paolillo Ugo Corrà Rosa Raimondo Antonio Cittadini Annamaria Iorio Andrea Salzano Rocco Lagioia Carlo Vignati Roberto Badagliacca Pasquale Perrone Filardi Michele Correale Enrico Perna Marco Metra Gaia Cattadori Marco Guazzi Giuseppe Limongelli Gianfranco Parati Fabiana De Martino Maria Vittoria Matassini Francesco Bandera Maurizio Bussotti Federica Re Carlo M. Lombardi Angela B. Scardovi Susanna Sciomer Andrea Passantino Caterina Santolamazza Davide Girola Claudio Passino Marlus Karsten Savina Nodari Giulio Pompilio MECKI score research group |
| author_facet | Piergiuseppe Agostoni Mattia Chiesa Elisabetta Salvioni Michele Emdin Massimo Piepoli Gianfranco Sinagra Michele Senni Alice Bonomi Stamatis Adamopoulos Dimitris Miliopoulos Massimo Mapelli Jeness Campodonico Umberto Attanasio Anna Apostolo Emanuele Pestrin Agostino Rossoni Damiano Magrì Stefania Paolillo Ugo Corrà Rosa Raimondo Antonio Cittadini Annamaria Iorio Andrea Salzano Rocco Lagioia Carlo Vignati Roberto Badagliacca Pasquale Perrone Filardi Michele Correale Enrico Perna Marco Metra Gaia Cattadori Marco Guazzi Giuseppe Limongelli Gianfranco Parati Fabiana De Martino Maria Vittoria Matassini Francesco Bandera Maurizio Bussotti Federica Re Carlo M. Lombardi Angela B. Scardovi Susanna Sciomer Andrea Passantino Caterina Santolamazza Davide Girola Claudio Passino Marlus Karsten Savina Nodari Giulio Pompilio MECKI score research group |
| author_sort | Piergiuseppe Agostoni |
| collection | DOAJ |
| description | Abstract Aims Individual prognostic assessment and disease evolution pathways are undefined in chronic heart failure (HF). The application of unsupervised learning methodologies could help to identify patient phenotypes and the progression in each phenotype as well as to assess adverse event risk. Methods and results From a bulk of 7948 HF patients included in the MECKI registry, we selected patients with a minimum 2‐year follow‐up. We implemented a topological data analysis (TDA), based on 43 variables derived from clinical, biochemical, cardiac ultrasound, and exercise evaluations, to identify several patients' clusters. Thereafter, we used the trajectory analysis to describe the evolution of HF states, which is able to identify bifurcation points, characterized by different follow‐up paths, as well as specific end‐stages conditions of the disease. Finally, we conducted a 5‐year survival analysis (composite of cardiovascular death, left ventricular assist device, or urgent heart transplant). Findings were validated on internal (n = 527) and external (n = 777) populations. We analyzed 4876 patients (age = 63 [53–71], male gender n = 3973 (81.5%), NYHA class I–II n = 3576 (73.3%), III–IV n = 1300 (26.7%), LVEF = 33 [25.5–39.9], atrial fibrillation n = 791 (16.2%), peak VO2% pred = 54.8 [43.8–67.2]), with a minimum 2‐year follow‐up. Nineteen patient clusters were identified by TDA. Trajectory analysis revealed a path characterized by 3 bifurcation and 4 end‐stage points. Clusters survival rate varied from 44% to 100% at 2 years and from 20% to 100% at 5 years, respectively. The event frequency at 5‐year follow‐up for each study cohort cluster was successfully compared with those in the validation cohorts (R = 0.94 and R = 0.84, P < 0.001, for internal and external cohort, respectively). Finally, we conducted a 5‐year survival analysis (composite of cardiovascular death, left ventricular assist device, or urgent heart transplant observed in 22% of cases). Conclusions Each HF phenotype has a specific disease progression and prognosis. These findings allow to individualize HF patient evolutions and to tailor assessment. |
| format | Article |
| id | doaj-art-7a3c8bb5d27d4b84a9a9883a97890d05 |
| institution | OA Journals |
| issn | 2055-5822 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-7a3c8bb5d27d4b84a9a9883a97890d052025-08-20T02:16:21ZengWileyESC Heart Failure2055-58222025-02-0112141843310.1002/ehf2.14966The chronic heart failure evolutions: Different fates and routesPiergiuseppe Agostoni0Mattia Chiesa1Elisabetta Salvioni2Michele Emdin3Massimo Piepoli4Gianfranco Sinagra5Michele Senni6Alice Bonomi7Stamatis Adamopoulos8Dimitris Miliopoulos9Massimo Mapelli10Jeness Campodonico11Umberto Attanasio12Anna Apostolo13Emanuele Pestrin14Agostino Rossoni15Damiano Magrì16Stefania Paolillo17Ugo Corrà18Rosa Raimondo19Antonio Cittadini20Annamaria Iorio21Andrea Salzano22Rocco Lagioia23Carlo Vignati24Roberto Badagliacca25Pasquale Perrone Filardi26Michele Correale27Enrico Perna28Marco Metra29Gaia Cattadori30Marco Guazzi31Giuseppe Limongelli32Gianfranco Parati33Fabiana De Martino34Maria Vittoria Matassini35Francesco Bandera36Maurizio Bussotti37Federica Re38Carlo M. Lombardi39Angela B. Scardovi40Susanna Sciomer41Andrea Passantino42Caterina Santolamazza43Davide Girola44Claudio Passino45Marlus Karsten46Savina Nodari47Giulio Pompilio48MECKI score research groupCentro Cardiologico Monzino, IRCCs Milan ItalyCentro Cardiologico Monzino, IRCCs Milan ItalyCentro Cardiologico Monzino, IRCCs Milan ItalyHealth Science Interdisciplinary Center, Scuola Superiore Sant'Anna Pisa ItalyDepartment of Clinical Cardiology IRCCS Policlinico San Donato Milan ItalyDepartment of Cardiology ‘Azienda Sanitaria Universitaria Giuliano‐Isontina’ Trieste ItalyDepartment of Cardiology, Unit of Cardiology ASST Papa Giovanni XXIII Bergamo ItalyCentro Cardiologico Monzino, IRCCs Milan ItalyHeart Failure and Heart Transplant Units Onassis Cardiac Surgery Centre Attica GreeceHeart Failure and Heart Transplant Units Onassis Cardiac Surgery Centre Attica GreeceCentro Cardiologico Monzino, IRCCs Milan ItalyCentro Cardiologico Monzino, IRCCs Milan ItalyFederico II University Naples ItalyCentro Cardiologico Monzino, IRCCs Milan ItalyUniversità degli studi di Trieste Trieste ItalyUniversità degli studi Milano Bicocca Milan ItalyDepartment of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea ‘Sapienza’ Università degli Studi di Roma Rome ItalyDipartimento di scienze biomediche avanzate Federico II University Naples ItalyDepartment of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS Veruno Institute Veruno ItalyDivisione di Cardiologia Riabilitativa Istituti Clinici Scientifici Maugeri Varese ItalyDepartment of Translational Medical Sciences Federico II University Naples ItalyDepartment of Cardiology, Unit of Cardiology ASST Papa Giovanni XXIII Bergamo ItalyCardiac Unit AORN A Cardarelli Naples ItalyUOC Cardiologia di Riabilitativa Mater Dei Hospital Bari ItalyCentro Cardiologico Monzino, IRCCs Milan ItalyDipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, ‘Sapienza’ Rome University Rome ItalyDepartment of Advanced Biomedical Sciences Federico II University of Naples and Mediterranea CardioCentro Naples ItalyDepartment of Cardiology University of Foggia Foggia ItalyDipartimento cardio‐toraco‐vascolare Ospedale Cà Granda‐ A.O. Niguarda Milan ItalyDepartment of Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health University of Brescia Brescia ItalyUnità Operativa Cardiologia Riabilitativa, IRCCS Multimedica Milan ItalyUniversity of Milano Milan ItalyCardiologia SUN, Ospedale Monaldi (Azienda dei Colli) Seconda Università di Napoli Naples ItalyDepartment of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital Istituto Auxologico Italiano, IRCCS Milan ItalyUnità funzionale di cardiologia Casa di Cura Tortorella Salerno ItalyDepartment of Cardiology, Division of Cardiac Intensive Care Unit‐Cardiology Ospedali Riuniti di Ancona Ancona ItalyDepartment of Biomedical Sciences for Health University of Milano Milan ItalyCardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS Scientific Institute of Milan Milan ItalyDivision of Cardiology, Cardiac Arrhythmia Center and Cardiomyopathies Unit San Camillo‐Forlanini Hospital Rome ItalyDepartment of Cardiology, Department of Medical and Surgical Specialities, Radiological Sciences, and Public Health University of Brescia Brescia ItalyDivision of Cardiology Santo Spirito Hospital Rome ItalyDipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, ‘Sapienza’ Rome University Rome ItalyDivision of Cardiology, Istituti Clinici Scientifici Maugeri Institute of Bari Bari ItalyDipartimento cardio‐toraco‐vascolare Ospedale Cà Granda‐ A.O. Niguarda Milan ItalyClinica Hildebrand Centro di Riabilitazione Brissago Brissago SwitzerlandHealth Science Interdisciplinary Center, Scuola Superiore Sant'Anna Pisa ItalyCentro Cardiologico Monzino, IRCCs Milan ItalyDepartment of Medical and Surgical Specialities, Radiological Sciences and Public Health University of Brescia Medical School Brescia ItalyCentro Cardiologico Monzino, IRCCs Milan ItalyAbstract Aims Individual prognostic assessment and disease evolution pathways are undefined in chronic heart failure (HF). The application of unsupervised learning methodologies could help to identify patient phenotypes and the progression in each phenotype as well as to assess adverse event risk. Methods and results From a bulk of 7948 HF patients included in the MECKI registry, we selected patients with a minimum 2‐year follow‐up. We implemented a topological data analysis (TDA), based on 43 variables derived from clinical, biochemical, cardiac ultrasound, and exercise evaluations, to identify several patients' clusters. Thereafter, we used the trajectory analysis to describe the evolution of HF states, which is able to identify bifurcation points, characterized by different follow‐up paths, as well as specific end‐stages conditions of the disease. Finally, we conducted a 5‐year survival analysis (composite of cardiovascular death, left ventricular assist device, or urgent heart transplant). Findings were validated on internal (n = 527) and external (n = 777) populations. We analyzed 4876 patients (age = 63 [53–71], male gender n = 3973 (81.5%), NYHA class I–II n = 3576 (73.3%), III–IV n = 1300 (26.7%), LVEF = 33 [25.5–39.9], atrial fibrillation n = 791 (16.2%), peak VO2% pred = 54.8 [43.8–67.2]), with a minimum 2‐year follow‐up. Nineteen patient clusters were identified by TDA. Trajectory analysis revealed a path characterized by 3 bifurcation and 4 end‐stage points. Clusters survival rate varied from 44% to 100% at 2 years and from 20% to 100% at 5 years, respectively. The event frequency at 5‐year follow‐up for each study cohort cluster was successfully compared with those in the validation cohorts (R = 0.94 and R = 0.84, P < 0.001, for internal and external cohort, respectively). Finally, we conducted a 5‐year survival analysis (composite of cardiovascular death, left ventricular assist device, or urgent heart transplant observed in 22% of cases). Conclusions Each HF phenotype has a specific disease progression and prognosis. These findings allow to individualize HF patient evolutions and to tailor assessment.https://doi.org/10.1002/ehf2.14966Cardiopulmonary exercise testHeart failurePrognosisTopological data analysis |
| spellingShingle | Piergiuseppe Agostoni Mattia Chiesa Elisabetta Salvioni Michele Emdin Massimo Piepoli Gianfranco Sinagra Michele Senni Alice Bonomi Stamatis Adamopoulos Dimitris Miliopoulos Massimo Mapelli Jeness Campodonico Umberto Attanasio Anna Apostolo Emanuele Pestrin Agostino Rossoni Damiano Magrì Stefania Paolillo Ugo Corrà Rosa Raimondo Antonio Cittadini Annamaria Iorio Andrea Salzano Rocco Lagioia Carlo Vignati Roberto Badagliacca Pasquale Perrone Filardi Michele Correale Enrico Perna Marco Metra Gaia Cattadori Marco Guazzi Giuseppe Limongelli Gianfranco Parati Fabiana De Martino Maria Vittoria Matassini Francesco Bandera Maurizio Bussotti Federica Re Carlo M. Lombardi Angela B. Scardovi Susanna Sciomer Andrea Passantino Caterina Santolamazza Davide Girola Claudio Passino Marlus Karsten Savina Nodari Giulio Pompilio MECKI score research group The chronic heart failure evolutions: Different fates and routes ESC Heart Failure Cardiopulmonary exercise test Heart failure Prognosis Topological data analysis |
| title | The chronic heart failure evolutions: Different fates and routes |
| title_full | The chronic heart failure evolutions: Different fates and routes |
| title_fullStr | The chronic heart failure evolutions: Different fates and routes |
| title_full_unstemmed | The chronic heart failure evolutions: Different fates and routes |
| title_short | The chronic heart failure evolutions: Different fates and routes |
| title_sort | chronic heart failure evolutions different fates and routes |
| topic | Cardiopulmonary exercise test Heart failure Prognosis Topological data analysis |
| url | https://doi.org/10.1002/ehf2.14966 |
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