Prognostic implications of machine learning-derived echocardiographic phenotypes in community hypertensive patients

Background Echocardiogram is commonly used to evaluate cardiac remodeling in hypertension (HTN). However, study on echocardiographic phenotypes and their prognostic implications in HTN is limited. Objective We aimed to evaluate the prognostic implications echocardiographic phenotypes in community hypertensive patients. Method A total of 1881 community hypertensive patients without overt cardiovascular disease and severe renal disease (mean age 62.8 years, women 57.9%) were included. Using Two-Step cluster analysis with four conventional echocardiographic variables, two clusters with distinct echocardiographic phenotypes were identified. Result The Cluster 1 (namely mild-remodeling HTN; n = 1492) had low prevalence of enlarged left atrium (LA; 0.9%) and left ventricular hypertrophy (LVH; 16.2%) and better LV diastolic function. They were younger and more likely to be men and had lower comorbid burden. The Cluster 2 (namely severe-remodeling HTN; n = 389) had higher prevalence of enlarged LA (26.0%) and LVH (83.0%) and worse LV diastolic function. They were older and more likely to be women and had higher comorbid burden. After a median follow-up of 4.2 years, compared to the Cluster 1, the Cluster 2 had higher incidence of cardiovascular (4.1% vs 1.7%; P = .006) and all-cause (9.8% vs 4.8%; P < .001) death, with adjusted hazard ratio of 2.80 (95% CI 1.39-5.62; P = .004) and 2.04 (95% CI 1.32-3.14; P < .001) respectively. Conclusion These findings indicate that the conventional echocardiographic variables-based algorithm could help identify asymptomatic community hypertensive patients at risk for cardiovascular and all-cause death. Further studies are needed to develop and validate phenotype-specific prevention and intervention strategies in HTN.

Automated summary

This study aimed to evaluate the prognostic implications of echocardiographic phenotypes in community hypertensive patients. Two distinct echocardiographic phenotypes were identified, namely mild-remodeling HTN and severe-remodeling HTN. The Cluster 2 (severe-remodeling HTN) had higher incidence of cardiovascular and all-cause death compared to the Cluster 1 (mild-remodeling HTN), indicating the potential of echocardiographic variables-based algorithm in identifying high-risk asymptomatic community hypertensive patients.