Left ventricle remodeling phenotypes and treatment adherence in patients with heart failure after acute myocardial infarction: cluster analysis of real-life clinical data
Abstract. Left ventricular (LV) remodeling after acute myocardial infarction (AMI) remains to be the main predictor of heart failure (HF) progression. Traditional approaches to risk stratification based on isolated echocardiographic parameters may not reflect the complexity of remodeling patterns. The aim: to identify LV remodeling phenotypes in patients with HF after AMI using cluster analysis methodic and to evaluate the effect of therapy adherence at the dynamics in echocardiographic parameters changes. Material and methods. A retrospective cohort study included 107 patients with HF after AMI and revascularization. K-means cluster analysis was performed for five baseline echocardiographic parameters: left ventricular ejection fraction (LVEF), end-diastolic volume, end-systolic volume, left atrial dimensions, and LV myocardial mass index. Dynamic clustering was performed using relative changes (Δ) after 6 months of observation. Adherence to therapy was assessed using the “proportion of days covered” index (PDC ≥ 80%). Results. Three initial clusters of patients were identified: cluster 1 (“Preserved geometry”: n = 42; 40%) with LVEF of 49.1%, normal LV volumes and minimal hypertrophy; cluster 2 (“Moderate remodeling”: n = 38; 36.2%) with LVEF of 43.7% and initial LV dilation; cluster 3 (“Severe remodeling”: n = 25; 23.8%) with LVEF of 35.8%, severe dilation and hypertrophy. Dynamic analysis (n = 89) revealed three patterns of LV remodeling: cluster A (“Reverse remodeling”: n = 34; 38.2%) with ΔLVEF +12.1%, decreased LV volumes; cluster B (“Stabilization”: n = 29; 32.6%) with minimal changes; Cluster C (“Progression”: n=26; 29.2%) with ΔLVEF -9.7% and increasing dilation. Patients adherent to the prescribed therapy were 12.4 times more likely to demonstrate reverse LV remodeling (OR 12.4; 95% CI: 4.1–37.6; p <0.001). Cross-analysis of clusters showed that 62% of patients with pronounced initial LV remodeling showed progression of this process, while 26% achieved reverse remodeling with high adherence to treatment. Conclusion. Cluster analysis allowed us to identify different phenotypes of LV remodeling with different trajectories. Adherence to therapy is a key modifiable factor determining the dynamics of remodeling: in adherent patients, the frequency of reverse LV remodeling is significantly higher, regardless of its initial phenotype.Fitilev S.B., Shkrebneva I.I., Klyuev D.A., Smirnov M.I.
Keywords
heart failure
myocardial infarction
left ventricular remodeling
cluster analysis
therapy adherence
echocardiography
left ventricular remodeling phenotypes
reverse left ventricular remodeling
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About the Authors
Sergey B. Fitilev, MD, Dr. Sci. (Medicine), professor of the Department of general and clinical pharmacology of the Medical institute RUDN University, clinical pharmacologist at City Polyclinic No. 2 of the Department of Healthcare of Moscow. Address: 117198, Moscow, 6 Mikloukho-Maklaya St.E-mail: fitilev_sb@pfur.ru
ORCID: https://orcid.org/0000-0001-8395-419X. Scopus ID: 6701762621. eLibrary SPIN: 8287-8456
Irina I. Shkrebneva, MD, PhD (Medicine), associate professor of the Department of general and clinical pharmacology of the Medical institute RUDN University, clinical pharmacologist at City Polyclinic No. 2 of the Department of Healthcare of Moscow. Address: 117198, Moscow, 6 Mikloukho-Maklaya St.
E-mail: shkrebneva_ii@pfur.ru
ORCID: https://orcid.org/0000-0002-0070-3115. Scopus ID: 57194377626. eLibrary SPIN: 1105-5760
Dmitry A. Klyuev, MD, PhD (Pharm. Sci.), assistant professor of the Department of general and clinical pharmacology of the Medical institute RUDN University. Address: 117198, Moscow, 6 Mikloukho-Maklaya St.
E-mail: kliuev_da@pfur.ru
ORCID: https://orcid.org/0000-0003-2400-3938. Scopus ID: 57221578965. eLibrary SPIN: 8960-7798
Mikhail I. Smirnov, MD, postgraduate student of the Department of general and clinical pharmacology of the Medical institute RUDN University. Address: 117198, Moscow, 6 Mikloukho-Maklaya St.
E-mail: smirn.michail@yandex.ru
ORCID: https://orcid.org/0009-0006-6428-1368
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