Elsevier

The American Journal of Cardiology

Volume 164, 1 February 2022, Pages 93-99
The American Journal of Cardiology

Phenomapping a Novel Classification System for Patients With Destination Therapy Left Ventricular Assist Devices

https://doi.org/10.1016/j.amjcard.2021.10.028Get rights and content

Patients with continuous flow destination therapy (DT) left ventricular assist devices (LVAD) comprise a heterogeneous population. We hypothesized that phenotypic clustering of individuals with DT LVADs by their implantation characteristics will be associated with different long-term risk profiles. We analyzed 5,999 patients with continuous flow DT LVADs in Interagency Registry for Mechanically Assisted Circulatory Support using 18 continuous variable baseline characteristics. We Z-transformed the variables and applied a Gaussian finite mixture model to perform unsupervised clustering resulting in identification of 4 phenogroups. Survival analyses considered the competing risk for cumulative incidence of transplant or the composite end point of death or heart transplant where appropriate. Phenogroup 1 (n = 1,163, 19%) was older (71 years) and primarily white (81%). Phenogroups 2 (n = 648, 11%) and 3 (n = 3,671, 61%) were of intermediate age (70 and 62 years), weight (85 and 87 kg), and ventricular size. Phenogroup 4 (n = 517, 9%) was younger (40 years), heavier (108 kg), and more racially diverse. The cumulative incidence of death, heart transplant, bleeding, LVAD malfunction, and LVAD thrombosis differed among phenogroups. The highest incidence of death and the lowest rate of heart transplant was seen in phenogroup 1 (p <0.001). For adverse outcomes, phenogroup 4 had the lowest incidence of bleeding, whereas LVAD device thrombosis and malfunction were lowest in phenogroup 1 (p <0.001 for all). Finally, the incidence of stroke, infection, and renal dysfunction were not statistically different. In conclusion, the present unsupervised machine learning analysis identified 4 phenogroups with different rates of adverse outcomes and these findings underscore the influence of phenotypic heterogeneity on post-LVAD implantation outcomes.

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Disclosures

Dr. Grodin receives grant support from Texas Health Resources. Dr. Grodin reports relations with Pfizer Inc that includes consulting or advisory. Dr. Grodin reports relations with Alnylam Pharmaceuticals Inc that includes consulting or advisory. Dr. Grodin reports relations with Eidos Therapeutics that includes consulting or advisory and funding grants. Dr. Grodin reports relations with Sarepta Therapeutics Inc that includes consulting or advisory. Dr. Pandey receives a grant support from Texas

Funding sources

JLG reports research funding from the Texas Health Resources Clinical Scholarship and Eidos and AP reports research funding from the Texas Health Resources Clinical Scholarship. MHD is supported by the James M. Wooten Chair in Cardiology.

Dr. Grodin receives a grant from Texas Health Resources. Dr. Grodin receives grants from Eidos Therapeutics. Dr. Pandey receives funding from Texas Health Resources. Dr. Drazner receives grants from James M. Wooten Chair in Cardiology.

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