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BACKGROUND: Patients with heart failure with reduced ejection fraction (HFrEF) and central sleep apnea (CSA) are at a very high risk of fatal outcomes. OBJECTIVE: To test whether the circulating miRNome provides additional information for risk stratification on top of clinical predictors in patients with HFrEF and CSA. METHODS: The study included patients with HFrEF and CSA from the SERVE-HF trial. A three-step protocol was applied: microRNA (miRNA) screening (n = 20), technical validation (n = 60), and biological validation (n = 587). The primary outcome was either death from any cause, lifesaving cardiovascular intervention, or unplanned hospitalization for worsening of heart failure, whatever occurred first. MiRNA quantification was performed in plasma samples using miRNA sequencing and RT-qPCR. RESULTS: Circulating miR-133a-3p levels were inversely associated with the primary study outcome. Nonetheless, miR-133a-3p did not improve a previously established clinical prognostic model in terms of discrimination or reclassification. A customized regression tree model constructed using the Classification and Regression Tree (CART) algorithm identified eight patient subphenotypes with specific risk patterns based on clinical and molecular characteristics. MiR-133a-3p entered the regression tree defining the group at the lowest risk; patients with log(NT-proBNP) ≤ 6 pg/mL (miR-133a-3p levels above 1.5 arbitrary units). The overall predictive capacity of suffering the event was highly stable over the follow-up (from 0.735 to 0.767). CONCLUSIONS: The combination of clinical information, circulating miRNAs, and decision tree learning allows the identification of specific risk subphenotypes in patients with HFrEF and CSA.
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Insuficiência Cardíaca , MicroRNAs , Apneia do Sono Tipo Central , Disfunção Ventricular Esquerda , Humanos , Apneia do Sono Tipo Central/complicações , Biomarcadores , Volume Sistólico , MicroRNAs/genética , Árvores de DecisõesRESUMO
Former under secretary of commerce and NIST director brings a focus on giving back and trust in science.
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Ceremony recognizes unexpected breakthroughs on pain relievers, microscopes, and laser surgery.
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Analgésicos não Narcóticos , Distinções e Prêmios , Terapia a Laser , Microscopia , ômega-Conotoxinas , Microscopia/instrumentaçãoRESUMO
Bhaumik Breakthrough of the Year Award to recognize individual researchers.
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Susan Rosenberg and Jane Maienschein elected to AAAS Board of Directors.
