1. Enhanced clinical phenotyping by mechanistic bioprofiling in heart failure with preserved ejection fraction
- Author
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Stephane Heymans, Kenneth McDonald, Marie-Dominique Devignes, Alexandre Mebazaa, Paolo Marino, Walter Paulus, Giuseppe Ambrosio, Loek van Heerebeek, Jean-Loup Machu, Carsten Tschöpe, Masatake Kobayashi, Alan G. Fraser, Svend Aakhus, Hans-Peter Brunner-La Rocca, Nicolas Girerd, Ricardo Fontes-Carvalho, Kevin Duarte, João Pedro Ferreira, Susan Stienen, Patrick Rossignol, Gilles W. De Keulenaer, Gregoire Preud'homme, Zoltán Papp, Emmanuel Bresso, Riccardo Raddino, Faiez Zannad, Daniela Dobre, Natalia López, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Department of Physiology and Cardiothoracic Surgery Cardiovascular Research and Development Unit Faculty of Medicine University of Porto, Centre Psychothérapique de Nancy (CPN), Computational Algorithms for Protein Structures and Interactions (CAPSID), Inria Nancy - Grand Est, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Department of Complex Systems, Artificial Intelligence & Robotics (LORIA - AIS), Laboratoire Lorrain de Recherche en Informatique et ses Applications (LORIA), Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire Lorrain de Recherche en Informatique et ses Applications (LORIA), Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Universidad Pública de Navarra [Espagne] = Public University of Navarra (UPNA), Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Department of Cardiology [Oslo], Oslo University Hospital [Oslo], ISB, Norwegian University of Science and Technology, Trondheim, Division of Cardiology, University of Perugia School of Medicine, Perugia, Department of Cardiology, Maastricht University Medical Center, Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Wales Heart Research Institute [Cardiff] (WHRI), Cardiff University, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences, Maastricht University, Department of Cardiovascular Sciences, Centre for Molecular and Vascular Biology, KU Leuven, William Harvey Research Institute, Barts Heart Centre, Queen Mary University of London, Laboratory of Physiopharmacology, Antwerp University, and ZNA Hartcentrum, Clinical Cardiology, Università del Piemonte Orientale, Department of Translational Medicine, Azienda Ospedaliero Universitaria 'Maggiore della Carità', St Michael's Hospital Dun Laoghaire Co. Dublin, Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université de Paris (UP), Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP)-Université Sorbonne Paris Nord, Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Department of Cardiology, Spedali Civili di Brescia, Charité Campus Virchow-Klinikum (CVK), Department of Cardiology, Campus Virchow-Klinikum, Charite Universitaetsmedizin Berlin, Berlin Institute of Health – Center for Regenerative Therapies (BIH-BCRT), and the German Center for Cardiovascular Research (DZHK, Berlin partner site), Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, This study was supported by a grant from the European Union (FP7-HEALTH-2010-MEDIA), by the French Programme Hospitalier de Recherche Clinique (PHRC) and by the RHU Fight-HF, a public grant overseen by the French National Research Agency (ANR) as part of the second 'Investissements d’Avenir' program (reference: ANR-15-RHU-0004), the GEENAGE (ANR-15-IDEX-04-LUE) program, by the Contrat de Plan Etat Région Lorraine and FEDER IT2MP.) N-LA was supported by a Miguel Servet contract CP13/00221 from the 'Instituto de Salud Carlos III-FEDER'. WJP and LvH were supported by CVON, Dutch Heart Foundation, The Hague, The Netherlands (RECONNECT and EARLY-HFpEF projects). AM received speaker's honoraria from Orion, Otsuka, Philips, Roche and Servier. AM received fees as member of advisory board and/or Steering Committee and/or research grant from Adrenomed, Epygon, Neurotronik, Roche, Sanofi and Sphyngotec. AM owns shares in S-Form Pharma. SS acknowledges funding received from the European Society of Cardiology in form of an ESC Research Grant (R-2018-18686). SH was supported by IMI2-CARDIATEAM (N° 821508), research grants from the Netherlands Organization for Scientific Research (NOW, Vidi 91796338), the Netherlands Cardiovascular Research Initiative, an initiative with support of the Dutch Heart Foundation, CVON2016-Early HFPEF, 2015-10, CVON She-PREDICTS, grant 2017-21, CVON Arena-PRIME, 2017-18 and the ERA-Net-CVD project MacroERA, 01KL1706, and FWO G091018N, ANR-15-RHUS-0004,FIGHT-HF,Combattre l'insuffisance cardiaque(2015), ANR-15-IDEX-0004,LUE,Isite LUE(2015), European Project: 261409,EC:FP7:HEALTH,FP7-HEALTH-2010-single-stage,MEDIA(2011), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Università degli Studi di Perugia = University of Perugia (UNIPG), Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), University of Antwerp (UA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, BOZEC, Erwan, Combattre l'insuffisance cardiaque - - FIGHT-HF2015 - ANR-15-RHUS-0004 - RHUS - VALID, ISITE - Isite LUE - - LUE2015 - ANR-15-IDEX-0004 - IDEX - VALID, The MEtabolic Road to DIAstolic Heart Failure - MEDIA - - EC:FP7:HEALTH2011-01-01 - 2016-06-30 - 261409 - VALID, Centre Psychothérapique de Nancy [Laxou] (CPN), Academic Medical Center, ACS - Heart failure & arrhythmias, Physiology, Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), RS: Carim - H02 Cardiomyopathy, Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL)-Institut National de Recherche en Informatique et en Automatique (Inria)-Laboratoire Lorrain de Recherche en Informatique et ses Applications (LORIA), and Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL)-Institut National de Recherche en Informatique et en Automatique (Inria)-Centre National de la Recherche Scientifique (CNRS)-Université de Lorraine (UL)
- Subjects
Male ,Proteomics ,ANGIOPOIETIN RECEPTOR TIE-2 ,Health, Toxicology and Mutagenesis ,Clinical Biochemistry ,Disease ,030204 cardiovascular system & hematology ,Logistic regression ,Bioinformatics ,Biochemistry ,DISEASE ,HFPEF ,0302 clinical medicine ,biomarkers ,cluster analysis ,complex-network analysis ,machine learning ,phenotype ,Pharmacology. Therapy ,HEPARIN-BINDING PROTEIN ,Diastolic heart failure ,Middle Aged ,Brain natriuretic peptide ,Phenotype ,[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,3. Good health ,PLASMA ANGIOPOIETIN-1 ,BRAIN NATRIURETIC PEPTIDE ,030220 oncology & carcinogenesis ,L-SELECTIN ,Female ,Engineering sciences. Technology ,EXPRESSION ,GROWTH-FACTOR ,DATABASE ,Diastole ,GRANULYSIN ,03 medical and health sciences ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Diabetes mellitus ,medicine ,Humans ,Biology ,Aged ,Heart Failure ,business.industry ,Stroke Volume ,medicine.disease ,business ,Heart failure with preserved ejection fraction - Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome for which clear evidence of effective therapies is lacking. Understanding which factors determine this heterogeneity may be helped by better phenotyping. An unsupervised statistical approach applied to a large set of biomarkers may identify distinct HFpEF phenotypes. Methods: Relevant proteomic biomarkers were analyzed in 392 HFpEF patients included in Metabolic Road to Diastolic HF (MEDIA-DHF). We performed an unsupervised cluster analysis to define distinct phenotypes. Cluster characteristics were explored with logistic regression. The association between clusters and 1-year cardiovascular (CV) death and/or CV hospitalization was studied using Cox regression. Results: Based on 415 biomarkers, we identified 2 distinct clusters. Clinical variables associated with cluster 2 were diabetes, impaired renal function, loop diuretics and/or betablockers. In addition, 17 biomarkers were higher expressed in cluster 2 vs. 1. Patients in cluster 2 vs. those in 1 experienced higher rates of CV death/CV hospitalization (adj. HR 1.93, 95% CI 1.12–3.32, p = 0.017). Complex-network analyses linked these biomarkers to immune system activation, signal transduction cascades, cell interactions and metabolism. Conclusion: Unsupervised machine-learning algorithms applied to a wide range of biomarkers identified 2 HFpEF clusters with different CV phenotypes and outcomes. The identified pathways may provide a basis for future research.Clinical significance More insight is obtained in the mechanisms related to poor outcome in HFpEF patients since it was demonstrated that biomarkers associated with the high-risk cluster were related to the immune system, signal transduction cascades, cell interactions and metabolism Biomarkers (and pathways) identified in this study may help select high-risk HFpEF patients which could be helpful for the inclusion/exclusion of patients in future trials. Our findings may be the basis of investigating therapies specifically targeting these pathways and the potential use of corresponding markers potentially identifying patients with distinct mechanistic bioprofiles most likely to respond to the selected mechanistically targeted therapies.
- Published
- 2020
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