{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:37:38Z","timestamp":1787510258354,"version":"build-2736575974"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T00:00:00Z","timestamp":1692921600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["R01-HL134893"],"award-info":[{"award-number":["R01-HL134893"]}]},{"name":"NIH","award":["R01-HL140224"],"award-info":[{"award-number":["R01-HL140224"]}]},{"name":"NIH","award":["K24-HL153669"],"award-info":[{"award-number":["K24-HL153669"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The classification and management of pulmonary hypertension (PH) is challenging due to clinical heterogeneity of patients. We sought to identify distinct multimorbid phenogroups of patients with PH that are at particularly high-risk for adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A hospital-based cohort of patients referred for right heart catheterization between 2005\u20132016 with PH were included. Key exclusion criteria were shock, cardiac arrest, cardiac transplant, or valvular surgery. K-prototypes was used to cluster patients into phenogroups based on 12 clinical covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 5208 patients with mean age 64\u00b112 years, 39% women, we identified 5 distinct multimorbid PH phenogroups with similar hemodynamic measures yet differing clinical outcomes: (1) \u201cyoung men with obesity\u201d, (2) \u201cwomen with hypertension\u201d, (3) \u201cmen with overweight\u201d, (4) \u201cmen with cardiometabolic and cardiovascular disease\u201d, and (5) \u201cmen with structural heart disease and atrial fibrillation.\u201d Over a median follow-up of 6.3 years, we observed 2182 deaths and 2002 major cardiovascular events (MACE). In age- and sex-adjusted analyses, phenogroups 4 and 5 had higher risk of MACE (HR 1.68, 95% CI 1.41\u20132.00 and HR 1.52, 95% CI 1.24\u20131.87, respectively, compared to the lowest risk phenogroup 1). Phenogroup 4 had the highest risk of mortality (HR 1.26, 95% CI 1.04\u20131.52, relative to phenogroup 1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cluster-based analyses identify patients with PH and specific comorbid cardiometabolic and cardiovascular disease burden that are at highest risk for adverse clinical outcomes. Interestingly, cardiopulmonary hemodynamics were similar across phenogroups, highlighting the importance of multimorbidity on clinical trajectory. Further studies are needed to better understand comorbid heterogeneity among patients with PH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0290553","type":"journal-article","created":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T13:29:14Z","timestamp":1692970154000},"page":"e0290553","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Identifying high risk clinical phenogroups of pulmonary hypertension through a clustering analysis"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2218-6742","authenticated-orcid":true,"given":"Paula","family":"Rambarat","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily 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