Phenotypic clusters of patients with heart failure and ejection fraction 40% or more: A comparative observational study


DOI: https://dx.doi.org/10.18565/therapy.2024.9.49-58

Larina V.N., Lunev V.I.

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow
Abstract. The efficacy of spironolactone as a part of quadruple therapy for chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF) is beyond doubts, but in case of EF ≥ 40%, the class of recommendations and level of evidence regarding the use of this drug are contradictory.
The aim: to evaluate the correlation between spironolactone intake and belonging to poor prognosis cluster (C) in patients aged 60 years or older with CHF and EF ≥ 40%.
Material and methods. 86 outpatients with CHF II–IV functional class were included in the study. 37.2% of them took spironolactone (main group, MG), 62.8% did not receive mineralocorticoid receptor antagonists (MCRA, comparison group, CG). A physical examination of the patients and echocardiography were performed with calculation of left ventricular global function index (LVGFI). Outcome events included all-cause mortality and hospitalization due to cardiovascular disease (CVD), and the follow-up period was 25 (20–36) months.
Results. Lethal outcome was recorded in 29.1% of patients: 12.5% in the MG, 38.9% in CG (odds ratio (OR) 3.44, p < 0.05). Hospitalizations due to CVD decompensation occurred in 51.2% of participants: 46.9% in MG and 53.7% in CG (p = 0.540). The optimal number of clusters was 2: 55.8% of observations in C1, 44.2% in C2. C1 is represented mainly by patients with FC II CHF (83%), coronary heart disease (85%), diabetes mellitus (58%), higher LVGFI values (22.7%), spironolactone intake (52%); C2 – patients with coronary heart disease (100%) and myocardial infarction (95%), chronic kidney disease (66%), lower LVGFI (20.0%), diuretics intake (68%). Spironolactone in C2 was taken by 18% of patients. Survival rate in C1 was higher than in C2 group (p = 0.002). The probability of spironolactone intake among patients in C1 was 4.8 times higher than in C2 group (p < 0.05), belonging to C1 among patients receiving this medicine was 3.6 times higher comparatively to those who were not taking MCRA (p < 0.05).
Conclusion. In case of spironolactone intake as a part of complex CHF therapy, better survival rate and a lower frequency of hospitalizations were fixed.
Keywords: global function index, mean survival time, cluster analysis, spironolactone, ejection fraction, hospitalization, heart failure, prognosis, mortality, outpatients
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About the Autors

Vera N. Larina, MD, Dr. Sci. (Medicine), professor, head of the Department of outpatient medicine of Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117513, Moscow,1 Ostrovityanova St.
E-mail: larinav@mail.ru
ORCID: https://orcid.org/0000-0001-7825-5597. eLibrary SPIN: 3674-9620
Viktor I. Lunev, MD, PhD (Medicine), assistant professor of Department of outpatient medicine of Faculty of general medicine, N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia. Address: 117513, Moscow, 1 Ostrovityanova St.
E-mail: sandvit@ya.ru
ORCID: https://orcid.org/0000-0001-9002-7749. eLibrary SPIN: 6618-7536


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