Clinical phenotypes of severe atrial cardiomyopathy and their outcome: A cluster analysis
Background: Atrial cardiomyopathy (AtCM) encompasses patients with diverse demographics and comorbidities. This study aimed to identify phenotype groups with similar clinical characteristics, compare their mortality and atrial fibrillation (AF) event rates, and assess predictors of mortality. Method...
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Elsevier
2025-06-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S235290672500082X |
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| author | R. Ilieva P. Kalaydzhiev B. Slavchev N. Spasova E. Kinova A. Goudev |
| author_facet | R. Ilieva P. Kalaydzhiev B. Slavchev N. Spasova E. Kinova A. Goudev |
| author_sort | R. Ilieva |
| collection | DOAJ |
| description | Background: Atrial cardiomyopathy (AtCM) encompasses patients with diverse demographics and comorbidities. This study aimed to identify phenotype groups with similar clinical characteristics, compare their mortality and atrial fibrillation (AF) event rates, and assess predictors of mortality. Methods and Results: We performed a hierarchical cluster analysis using Ward’s Method, based on 11 clinical variables. Among 724 consecutive patients with a dilated left atrium (LA), only 196 met the criterion for severe AtCM- defined as a dilated LA with a volume index ≥ 50 ml/m2. We identified 4 clusters: Cluster 1 −younger overweight patients with paroxysmal AF; Cluster 2 −older patients with heart failure (HF) and low BMI; Cluster 3 − diabetic patients with HF; and Cluster 4 − older patients with tachycardia-bradycardia syndrome and implanted pacemakers. Over a median follow-up of 20.6 months, Cluster 2 had the highest mortality rate (29.1 %), followed by Cluster 3 (20.6 %), compared to Clusters 1 and 4 (11.4 % and 10.8 %, respectively, p = 0.045). For AF events, Cluster 1 had the highest incidence (37 %), followed by Cluster 3 (35 %), Cluster 2 (24 %), and Cluster 4 (19 %, p = 0.309). Heart failure (HR 4.4, CI 1.5–12.7, p = 0.006), cancer (HR 3.3, CI 1.6–6.9, p = 0.002), and severe tricuspid regurgitation (HR 5.4, CI 2.6–11.3, p < 0.001) were predictors of poor outcomes. Conclusion: In severe AtCM patients, four clusters were identified, each with unique comorbidities and mortality rates but similar AF event rates. Clinical and echocardiographic factors were linked to higher mortality risk. |
| format | Article |
| id | doaj-art-a9970124ce72401bb229ed45148a037b |
| institution | Kabale University |
| issn | 2352-9067 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj-art-a9970124ce72401bb229ed45148a037b2025-08-20T03:49:46ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672025-06-015810167910.1016/j.ijcha.2025.101679Clinical phenotypes of severe atrial cardiomyopathy and their outcome: A cluster analysisR. Ilieva0P. Kalaydzhiev1B. Slavchev2N. Spasova3E. Kinova4A. Goudev5Cardiology Clinic, University Hospital “Tsaritsa Yoanna- USUL” Sofia, Department of Emergency Medicine, Medical University Sofia, Bulgaria; Corresponding author at: Byalo more Str. 8, 1527 Sofia, Bulgaria.Cardiology Clinic, University Hospital “Tsaritsa Yoanna- USUL” Sofia, Department of Emergency Medicine, Medical University Sofia, BulgariaCardiology Practice Slavchevi, Sofia University, Sofia, BulgariaCardiology Clinic, University Hospital “Tsaritsa Yoanna- USUL” Sofia, Department of Emergency Medicine, Medical University Sofia, BulgariaCardiology Clinic, University Hospital “Tsaritsa Yoanna- USUL” Sofia, Department of Emergency Medicine, Medical University Sofia, BulgariaCardiology Clinic, University Hospital “Tsaritsa Yoanna- USUL” Sofia, Department of Emergency Medicine, Medical University Sofia, BulgariaBackground: Atrial cardiomyopathy (AtCM) encompasses patients with diverse demographics and comorbidities. This study aimed to identify phenotype groups with similar clinical characteristics, compare their mortality and atrial fibrillation (AF) event rates, and assess predictors of mortality. Methods and Results: We performed a hierarchical cluster analysis using Ward’s Method, based on 11 clinical variables. Among 724 consecutive patients with a dilated left atrium (LA), only 196 met the criterion for severe AtCM- defined as a dilated LA with a volume index ≥ 50 ml/m2. We identified 4 clusters: Cluster 1 −younger overweight patients with paroxysmal AF; Cluster 2 −older patients with heart failure (HF) and low BMI; Cluster 3 − diabetic patients with HF; and Cluster 4 − older patients with tachycardia-bradycardia syndrome and implanted pacemakers. Over a median follow-up of 20.6 months, Cluster 2 had the highest mortality rate (29.1 %), followed by Cluster 3 (20.6 %), compared to Clusters 1 and 4 (11.4 % and 10.8 %, respectively, p = 0.045). For AF events, Cluster 1 had the highest incidence (37 %), followed by Cluster 3 (35 %), Cluster 2 (24 %), and Cluster 4 (19 %, p = 0.309). Heart failure (HR 4.4, CI 1.5–12.7, p = 0.006), cancer (HR 3.3, CI 1.6–6.9, p = 0.002), and severe tricuspid regurgitation (HR 5.4, CI 2.6–11.3, p < 0.001) were predictors of poor outcomes. Conclusion: In severe AtCM patients, four clusters were identified, each with unique comorbidities and mortality rates but similar AF event rates. Clinical and echocardiographic factors were linked to higher mortality risk.http://www.sciencedirect.com/science/article/pii/S235290672500082XAtrial cardiomyopathyPhenotype groupsMortalityAtrial fibrillationHeart failure |
| spellingShingle | R. Ilieva P. Kalaydzhiev B. Slavchev N. Spasova E. Kinova A. Goudev Clinical phenotypes of severe atrial cardiomyopathy and their outcome: A cluster analysis International Journal of Cardiology: Heart & Vasculature Atrial cardiomyopathy Phenotype groups Mortality Atrial fibrillation Heart failure |
| title | Clinical phenotypes of severe atrial cardiomyopathy and their outcome: A cluster analysis |
| title_full | Clinical phenotypes of severe atrial cardiomyopathy and their outcome: A cluster analysis |
| title_fullStr | Clinical phenotypes of severe atrial cardiomyopathy and their outcome: A cluster analysis |
| title_full_unstemmed | Clinical phenotypes of severe atrial cardiomyopathy and their outcome: A cluster analysis |
| title_short | Clinical phenotypes of severe atrial cardiomyopathy and their outcome: A cluster analysis |
| title_sort | clinical phenotypes of severe atrial cardiomyopathy and their outcome a cluster analysis |
| topic | Atrial cardiomyopathy Phenotype groups Mortality Atrial fibrillation Heart failure |
| url | http://www.sciencedirect.com/science/article/pii/S235290672500082X |
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