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Mirna M, Berezin A, Schmutzler L, Demirel O, Hoppe UC, Lichtenauer M. Early beta-blocker therapy improves in-hospital mortality of patients with non-ST-segment elevation myocardial infarction - a meta-analysis. Int J Cardiol 2023; 389:131160. [PMID: 37423571 DOI: 10.1016/j.ijcard.2023.131160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Although current guidelines endorse early beta-blocker therapy in stable patients with STEMI, there is no clear recommendation on the early use of these drugs in patients with NSTEMI. METHODS Literature search was conducted by 3 independent researchers using PubMed/MEDLINE, CDSR, CENTRAL, CCAs, EBM Reviews, Web of Science and LILACS. Studies were eligible if (P) patients included were ≥ 18 years of age and had non-ST-segment elevation myocardial infarction (NSTEMI), (I) early (<24 h) treatment with intravenous or oral beta-blockers was compared to (C) no treatment with beta-blockers and data on (O) in-hospital mortality and/or in-hospital cardiogenic shock were depicted. Odds ratios and 95% confidence intervals were calculated using random effects models with the Mantel-Haenszel method. The Hartung-Knapp-Sidik-Jonkman method was used as estimator for τ2. RESULTS 977 records were screened for eligibility, which led to the inclusion of 4 retrospective, nonrandomized, observational cohort studies comprising a total of N = 184,951 patients. After pooling of the effect sizes, early therapy with beta-blockers resulted in a reduction of in-hospital mortality (OR 0.43 [0.36-0.51], p = 0.0022) despite no significant effect on the prevalence of cardiogenic shock (OR 0.36 [0.07-1.91], p = 0.1196). CONCLUSION Early treatment with beta-blockers was associated with an attenuation of in-hospital mortality despite no increase in cardiogenic shock. Thus, early therapy with these drugs could elicit beneficial effects on top of reperfusion therapy, similar to the effects seen in STEMI-patients. The low number of studies (k = 4) has to be considered when interpreting the findings of this analysis.
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Affiliation(s)
- Moritz Mirna
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Austria.
| | - Alexander Berezin
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Austria
| | - Lukas Schmutzler
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Austria
| | - Ozan Demirel
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Austria
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Austria
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Khan O, Patel M, Tomdio AN, Beall J, Jovin IS. Beta-Blockers in the Prevention and Treatment of Ischemic Heart Disease: Evidence and Clinical Practice. Heart Views 2023; 24:41-49. [PMID: 37124437 PMCID: PMC10144413 DOI: 10.4103/heartviews.heartviews_75_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/02/2022] [Indexed: 02/25/2023] Open
Abstract
Coronary artery disease (CAD) is the most prevalent cardiovascular disease characterized by atherosclerotic plaque buildup that can lead to partial or full obstruction of blood flow in the coronary arteries. Treatment for CAD involves a combination of lifestyle changes, pharmacologic therapy, and modern revascularization procedures. Beta-adrenoceptor antagonists (or beta-blockers) have been widely used for decades as a key therapy for CAD. In this review, prior studies are examined to better understand beta-adrenoceptor antagonist use in patients with acute coronary syndrome, stable coronary heart disease, and in the perioperative setting. The evidence for the benefit of beta-blocker therapy is well established for patients with acute myocardial infarction, but it diminishes as the time from the index cardiac event elapses. The evidence for benefit in the perioperative setting is not strong.
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Affiliation(s)
- Omer Khan
- Department of Medicine, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
| | - Murti Patel
- Department of Medicine, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Anna N. Tomdio
- Department of Medicine, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jeffrey Beall
- Department of Medicine, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
| | - Ion S. Jovin
- Department of Medicine, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
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3
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Furtado RH, Juliasz MG, Chiu FY, Bastos LB, Dalcoquio TF, Lima FG, Rosa R, Caporrino CA, Bertolin A, Genestreti PR, Ribeiro AS, Andrade MC, Giraldez RR, Baracioli LM, Zelniker TA, Nicolau JC. Long-term mortality after acute coronary syndromes among patients with normal, mildly reduced, or reduced ejection fraction. ESC Heart Fail 2022; 10:442-452. [PMID: 36274250 PMCID: PMC9871723 DOI: 10.1002/ehf2.14201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/15/2022] [Accepted: 09/29/2022] [Indexed: 01/29/2023] Open
Abstract
AIMS Left ventricular ejection fraction (LVEF) ≤ 40% is a well-established risk factor for mortality after acute coronary syndromes (ACS). However, the long-term prognostic impact of mildly reduced ejection fraction (EF) (LVEF 41-49%) after ACS remains less clear. METHODS AND RESULTS This was a retrospective study enrolling patients admitted with ACS included in a single-centre databank. LVEF was assessed by echocardiography during index hospitalization. Patients were divided in the following categories according to LVEF: normal (LVEF ≥ 50%), mildly reduced (LVEF 41-49%), and reduced (LVEF ≤ 40%). The endpoint of interest was all-cause death after hospital discharge. A multivariable Cox model was used to adjust for confounders. A total of 3200 patients were included (1952 with normal EF, 375 with mildly reduced EF, and 873 with reduced EF). The estimated cumulative incidence rates of mortality at 10 years for patients with normal, mildly reduced, and reduced EF were 24.8%, 33.5%, and 41.3%, respectively. After adjustments, the presence of reduced EF was associated with higher mortality compared with normal EF [adjusted hazard ratio (HR) 1.64; 95% confidence interval (CI) 1.36-1.96; P < 0.001], as was mildly reduced EF compared with normal EF (adjusted HR 1.33; 95% CI 1.05-1.68; P = 0.019). The presence of reduced EF was not associated with a statistically significantly higher mortality compared with mildly reduced EF (adjusted HR 1.23; 95% CI 0.96-1.57; P = 0.095). CONCLUSIONS In patients with ACS, mildly reduced EF measured in the acute phase was associated with higher long-term mortality compared with patients with normal EF. These data emphasize the importance of anti-remodelling therapies for ACS patients who have LVEF in the mildly reduced range.
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Affiliation(s)
- Remo H.M. Furtado
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil,Academic Research OrganizationHospital Israelita Albert EinsteinSão PauloBrazil
| | - Marcela G. Juliasz
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Felipe Y.J. Chiu
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Livia B.C. Bastos
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Talia F. Dalcoquio
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Felipe G. Lima
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Renato Rosa
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Cesar A. Caporrino
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Adriadne Bertolin
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Paulo R.R. Genestreti
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Andre S. Ribeiro
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Maria Carolina Andrade
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Roberto R.C.V. Giraldez
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | - Luciano M. Baracioli
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
| | | | - Jose C. Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de MedicinaUniversidade de São PauloSão PauloBrazil
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Bruno TC, Bittencourt MS, Quidim AVL, Santos I, Lotufo P, Bensenor I, Goulart A. The Prognosis of Coronary Artery Disease in a Brazilian Community Hospital: Findings from the ERICO Study. Arq Bras Cardiol 2021; 117:978-985. [PMID: 34644783 PMCID: PMC8682093 DOI: 10.36660/abc.20200399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/02/2020] [Indexed: 11/19/2022] Open
Abstract
Fundamento O prognóstico de longo prazo pós síndrome coronária aguda (SCA) no cuidado secundário não é bem conhecido. A gravidade da doença arterial coronariana (DAC) como preditor de mortalidade no longo prazo foi avaliada em um hospital público no Brasil. Objetivo O objetivo deste estudo foi comparar o prognóstico de curto e longo prazo após um evento de SCA, de acordo com a gravidade da doença obstrutiva, em pacientes atendidos em um hospital público secundário para um coorte prospectivo sobre DAC no Brasil (o Estudo de Registro de Insuficiência Coronariana, estudo ERICO) Métodos Foram realizadas análises de sobrevida por curvas de Kaplan-Meier e modelo de risco proporcional de Cox [razão de risco (RR) com o respectivo intervalo de confiança (IC) de 95% para avaliar mortalidade cumulativa global, por DCV e DAC, de acordo com a obstrução arterial coronária: sem obstrução (grupo de referência), doença de um vaso, doença de dois vasos, doença de múltiplos vasos] entre 800 adultos do estudo ERICO durante 4 anos de monitoramento. As RR são apresentadas como dados brutos e posteriormente padronizadas quanto a possíveis fatores de confusão, no período de 180 dias até 4 anos de monitoramento após a SCA. O p-valor <0.05 foi considerado estatisticamente significativo. Resultados Taxas de sobrevida mais baixas foram detectadas entre indivíduos com a doença de múltiplos vasos (global, DCV e DAC, p de teste de Log-rank <0,0001). Depois da padronização multivariada, a doença de múltiplos vasos [RR; 2,33 (IC 95%; 1,10-4,95)] e doença de um vaso obstruído [RR; 2,44 (IC 95%; 1,11-5,34)] tiveram o risco mais alto de mortalidade global comparadas aos índices dos sujeitos sem obstrução no monitoramento de 4 anos. Conclusões Não só os pacientes com doença de múltiplos vasos como também os com doença de um vaso tiveram alto risco de mortalidade no longo prazo pós-SCA. Esses achados destacam a importância de se ter uma abordagem melhor no tratamento e no controle de fatores de risco cardiovascular, mesmo em indivíduos com risco aparentemente baixo, atendidos em cuidado secundário.
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Affiliation(s)
- Tatiana Cristina Bruno
- Universidade de São Paulo, Hospital Universitário de São Paulo - Centro de Pesquisa Clínica e Epidemiológica, São Paulo, SP - Brasil
| | - Marcio Sommer Bittencourt
- Universidade de São Paulo, Hospital Universitário de São Paulo - Centro de Pesquisa Clínica e Epidemiológica, São Paulo, SP - Brasil
| | - Alessandra V L Quidim
- Universidade de São Paulo, Hospital Universitário de São Paulo - Centro de Pesquisa Clínica e Epidemiológica, São Paulo, SP - Brasil
| | - Itamar Santos
- Universidade de São Paulo, Hospital Universitário de São Paulo - Centro de Pesquisa Clínica e Epidemiológica, São Paulo, SP - Brasil
| | - Paulo Lotufo
- Universidade de São Paulo, Hospital Universitário de São Paulo - Centro de Pesquisa Clínica e Epidemiológica, São Paulo, SP - Brasil
| | - Isabela Bensenor
- Universidade de São Paulo, Hospital Universitário de São Paulo - Centro de Pesquisa Clínica e Epidemiológica, São Paulo, SP - Brasil
| | - Alessandra Goulart
- Universidade de São Paulo, Hospital Universitário de São Paulo - Centro de Pesquisa Clínica e Epidemiológica, São Paulo, SP - Brasil
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Nicolau JC, Feitosa Filho GS, Petriz JL, Furtado RHDM, Précoma DB, Lemke W, Lopes RD, Timerman A, Marin Neto JA, Bezerra Neto L, Gomes BFDO, Santos ECL, Piegas LS, Soeiro ADM, Negri AJDA, Franci A, Markman Filho B, Baccaro BM, Montenegro CEL, Rochitte CE, Barbosa CJDG, Virgens CMBD, Stefanini E, Manenti ERF, Lima FG, Monteiro Júnior FDC, Correa Filho H, Pena HPM, Pinto IMF, Falcão JLDAA, Sena JP, Peixoto JM, Souza JAD, Silva LSD, Maia LN, Ohe LN, Baracioli LM, Dallan LADO, Dallan LAP, Mattos LAPE, Bodanese LC, Ritt LEF, Canesin MF, Rivas MBDS, Franken M, Magalhães MJG, Oliveira Júnior MTD, Filgueiras Filho NM, Dutra OP, Coelho OR, Leães PE, Rossi PRF, Soares PR, Lemos Neto PA, Farsky PS, Cavalcanti RRC, Alves RJ, Kalil RAK, Esporcatte R, Marino RL, Giraldez RRCV, Meneghelo RS, Lima RDSL, Ramos RF, Falcão SNDRS, Dalçóquio TF, Lemke VDMG, Chalela WA, Mathias Júnior W. Brazilian Society of Cardiology Guidelines on Unstable Angina and Acute Myocardial Infarction without ST-Segment Elevation - 2021. Arq Bras Cardiol 2021; 117:181-264. [PMID: 34320090 PMCID: PMC8294740 DOI: 10.36660/abc.20210180] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- José Carlos Nicolau
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Gilson Soares Feitosa Filho
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
- Centro Universitário de Tecnologia e Ciência (UniFTC), Salvador, BA - Brasil
| | - João Luiz Petriz
- Hospital Barra D'Or, Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
| | | | | | - Walmor Lemke
- Clínica Cardiocare, Curitiba, PR - Brasil
- Hospital das Nações, Curitiba, PR - Brasil
| | | | - Ari Timerman
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | - José A Marin Neto
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, SP - Brasil
| | | | - Bruno Ferraz de Oliveira Gomes
- Hospital Barra D'Or, Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | - Carlos Eduardo Rochitte
- Hospital do Coração (HCor), São Paulo, SP - Brasil
- Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Edson Stefanini
- Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brasil
| | | | - Felipe Gallego Lima
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | - José Maria Peixoto
- Universidade José do Rosário Vellano (UNIFENAS), Belo Horizonte, MG - Brasil
| | - Juliana Ascenção de Souza
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Lilia Nigro Maia
- Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP - Brasil
| | | | - Luciano Moreira Baracioli
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luís Alberto de Oliveira Dallan
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Luis Augusto Palma Dallan
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Luiz Carlos Bodanese
- Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS - Brasil
| | | | | | - Marcelo Bueno da Silva Rivas
- Rede D'Or São Luiz, Rio de Janeiro, RJ - Brasil
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Múcio Tavares de Oliveira Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Nivaldo Menezes Filgueiras Filho
- Universidade do Estado da Bahia (UNEB), Salvador, BA - Brasil
- Universidade Salvador (UNIFACS), Salvador, BA - Brasil
- Hospital EMEC, Salvador, BA - Brasil
| | - Oscar Pereira Dutra
- Instituto de Cardiologia - Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Otávio Rizzi Coelho
- Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, SP - Brasil
| | | | | | - Paulo Rogério Soares
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | - Roberto Esporcatte
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | - Talia Falcão Dalçóquio
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - William Azem Chalela
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Wilson Mathias Júnior
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
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Gu J, Pan JA, Lin H, Zhang JF, Wang CQ. Characteristics, prognosis and treatment response in distinct phenogroups of heart failure with preserved ejection fraction. Int J Cardiol 2020; 323:148-154. [PMID: 32860842 DOI: 10.1016/j.ijcard.2020.08.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/05/2020] [Accepted: 08/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome. We aimed to derive HFpEF phenotype-based groups based on clinical features using machine learning, and to compare clinical characteristics, outcomes and treatment response across the phenogroups. METHODS We applied model-based clustering to 11 clinical and laboratory variables collected in 970 HFpEF patients. An additional 290 HFpEF patients was enrolled as a validation cohort. During 5-year follow-up, all-cause mortality was used as the primary endpoints, and composite endpoints (all-cause mortality or HF hospitalization) were set as the secondary endpoint. RESULTS We identified three phenogroups, for which significant differences in the age and gender, the prevalence of concomitant ischaemic heart disease, atrial fibrillation and type 2 diabetes mellitus, the burden of B-type natriuretic peptide level and HF symptoms. Patients with phenogroup 3 had higher all-cause mortality or composite endpoints, whereas patients in phenogroup 1 had less adverse events after 5-year follow-up. Moreover, it was indicated that beta-blockers or angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) use was associated with a lower risk of all-cause mortality or composite endpoints in phenogroup 3, instead of the other phenogroups. This HFpEF phenogroup classification, including its ability to stratify risk, was successfully replicated in a prospective validation cohort. CONCLUSION Machine-learning based clustering strategy is used to identify three distinct phenogroups of HFpEF that are characterized by significant differences in comorbidity burden, underlying cardiac abnormalities, and long-term prognosis. Beta-blockers or ACEI/ARB therapy is associated with a lower risk of adverse events in specific phenogroup.
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Affiliation(s)
- Jun Gu
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Jian-An Pan
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Hao Lin
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Jun-Feng Zhang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
| | - Chang-Qian Wang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
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7
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Beta-blocker Therapy in Acute Coronary Syndromes: a Time-Trend Interpretation of Evolving Clinical Benefits : Editorial to: "The Use of Oral Beta-Blockers and Clinical Outcomes in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes: a Long-Term Follow-up Study" by J.C. Nicolau et al. Cardiovasc Drugs Ther 2018; 32:409-411. [PMID: 30238210 DOI: 10.1007/s10557-018-6829-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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