BACKGROUND Many individual echocardiographic variables have been associated with heart failure (HF) in patients with stable coronary artery disease (CAD), but their combined utility for prediction has not been well studied. METHODS Unsupervised model-based cluster analysis was performed by researchers blinded to the study outcome in 1,000 patients with stable CAD on 15 transthoracic echocardiographic variables. We evaluated associations of cluster membership with HF hospitalization using Cox proportional hazards regression analysis. RESULTS The echo-derived clusters partitioned subjects into four phenogroupings: phenogroup 1 (n = 85) had the highest levels, phenogroups 2 (n = 314) and 3 (n = 205) displayed intermediate levels, and phenogroup 4 (n = 396) had the lowest levels of cardiopulmonary structural and functional abnormalities. Over 7.1 ± 3.2 years of follow-up, there were 198 HF hospitalizations. After multivariable adjustment for traditional cardiovascular risk factors, phenogroup 1 was associated with a nearly fivefold increased risk (hazard ratio [HR] = 4.8; 95% CI, 2.4-9.5), phenogroup 2 was associated with a nearly threefold increased risk (HR = 2.7; 95% CI, 1.4-5.0), and phenogroup 3 was associated with a nearly twofold increased risk (HR = 1.9; 95% CI, 1.0-3.8) of HF hospitalization, relative to phenogroup 4. CONCLUSIONS Transthoracic echocardiographic variables can be used to classify stable CAD patients into separate phenogroupings that differentiate cardiopulmonary structural and functional abnormalities and can predict HF hospitalization, independent of traditional cardiovascular risk factors.

中文翻译：

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超声心动图变量与稳定型冠状动脉疾病心力衰竭的机器学习衍生表型的关联：心脏和灵魂研究。

背景 许多单独的超声心动图变量与稳定型冠状动脉疾病 (CAD) 患者的心力衰竭 (HF) 相关，但它们在预测方面的综合效用尚未得到充分研究。方法 无监督的基于模型的聚类分析由对 1,000 名稳定型 CAD 患者的 15 个经胸超声心动图变量的研究结果不知情的研究人员进行。我们使用 Cox 比例风险回归分析评估集群成员与 HF 住院之间的关联。结果回声衍生的集群将受试者分为四个表型：表型 1 (n = 85) 具有最高水平，表型 2 (n = 314) 和表型 3 (n = 205) 显示中等水平，表型 4 (n = 396)具有最低水平的心肺结构和功能异常。超过 7。1 ± 3.2 年的随访中，有 198 人因心衰住院。在对传统心血管危险因素进行多变量调整后，表型 1 的风险增加近 5 倍（风险比 [HR] = 4.8；95% CI，2.4-9.5），表型 2 的风险增加近三倍（HR = 2.7；95% CI，1.4-5.0），而表型 3 与 HF 住院的风险增加近两倍（HR = 1.9；95% CI，1.0-3.8）相关，相对于表型 4。结论用于将稳定的 CAD 患者分为不同的表型分组，以区分心肺结构和功能异常，并可以预测 HF 住院，独立于传统的心血管危险因素。