Phenomapping in patients experiencing worsening renal function during hospitalization for acute heart failure

Ryuichiro Yagi, Makoto Takei, Shun Kohsaka, Yasuyuki Shiraishi, Nobuhiro Ikemura, Satoshi Shoji, Nozomi Niimi, Satoshi Higuchi, Ayumi Goda, Takashi Kohno, Yuji Nagatomo, Yosuke Nishihata, Yasumori Sujino, Mike Saji, Yukinori Ikegami, Shintaro Nakano, Toshiyuki Takahashi, Keiichi Fukuda, Tsutomu Yoshikawa

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Aims: The impact of worsening renal function (WRF) on the prognosis of patients with acute heart failure (AHF) remains controversial. We aimed to identify phenotypically distinct subgroups among individuals with both AHF and WRF using cluster analysis. Methods and results: Overall, the data of 483 patients with both AHF and WRF enrolled in the West Tokyo Heart Failure Registry were analysed. Using cluster analysis, we identified three phenotypically distinct subgroups (phenogroups 1, 2, and 3). We assessed the impact of WRF on the prognosis of each phenogroup by comparing the incidence of composite endpoints, including all-cause death and re-hospitalization due to heart failure, with those of a propensity score-matched, non-WRF control group. Participants in phenogroup 1 (N = 122) were the youngest (69.3 ± 13.7 years), had relatively preserved estimated glomerular filtration rate (eGFR, 70.0 ± 27.7 mL/min/1.73 m2), and reduced left ventricular ejection fraction (LVEF) (41.8 ± 13.7%). Conversely, participants in phenogroup 3 (N = 122) were the oldest (81.7 ± 8.5 years), had the worst eGFR (33.0 ± 20.9 mL/min/1.73 m2), and had preserved LVEF (51.7 ± 14.8%). The characteristics of the participants in phenogroup 2 (N = 239) were between those of phenogroups 1 and 3. The propensity score matching analysis showed that WRF was associated with a higher incidence of composite endpoints in phenogroup 1, whereas this association was not observed in phenogroups 2 and 3. Conclusions: Using cluster analysis, we revealed three phenotypically distinct subgroups of patients with both AHF and WRF. WRF was associated with worse clinical outcomes in the subgroup of younger patients with reduced LVEF and preserved renal function.

Original languageEnglish
Pages (from-to)5192-5203
Number of pages12
JournalESC Heart Failure
Issue number6
Publication statusPublished - 2021 Dec

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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