{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:59:32Z","timestamp":1790618372377,"version":"4.1.0"},"reference-count":41,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome. Atrial remodeling represents an important dimension of HFpEF beyond the presence of atrial fibrillation (AF). We aimed to identify clinically meaningful atrial phenotypes using unsupervised clustering. Methods: Overall, 153 patients were analyzed from a prospective HFpEF registry who underwent clinical assessment, laboratory testing, electrocardiography, resting and stress echocardiography and cardiopulmonary exercise testing. Consensus k-means clustering across multiply imputed datasets integrated markers of atrial structure and function, biomarkers, and hemodynamic burden. Clinical characteristics, functional capacity, quality of life and 12-month healthcare utilization were compared between clusters. Sensitivity analyses assessed cluster robustness. Results: Two phenotypes were identified. Cluster 1 (n = 66) was characterized by higher biomarker and hemodynamic burden, impaired renal function, larger left atrial volume index, and reduced left atrial reservoir strain. Variables not included in cluster generation also differed between phenotypes: Cluster 1 showed poorer exercise capacity, shorter six-minute walking distance, worse quality of life, and a higher observed all-cause hospitalization burden. The hospitalization finding was considered exploratory. The principal cluster structure was preserved in sensitivity analyses, including complete-case analysis. Conclusions: The clustering approach identified an HFpEF phenotype characterized by biomarker elevation and advanced atrial remodeling. The phenotype was associated with greater functional impairment and adverse patient-reported characteristics. These clinical associations support the potential relevance of multidimensional atrial phenotyping, although the findings remain hypothesis-generating and require validation in independent cohorts.<\/jats:p>","DOI":"10.3390\/jcm15197538","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T16:50:54Z","timestamp":1790614254000},"page":"7538","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cluster-Based Phenotyping in an HFpEF Population Identifies a Biomarker-High, Atrial-Dysfunction Phenotype with Impaired Quality of Life, Reduced Exercise Capacity and Higher Healthcare Utilization"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9325-0023","authenticated-orcid":false,"given":"Sophia","family":"Haack","sequence":"first","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Frank","family":"Edelmann","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9platz 1, 10117 Berlin, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Fabian","family":"Spinka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9platz 1, 10117 Berlin, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8847-5574","authenticated-orcid":false,"given":"Andreas","family":"Kind","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9platz 1, 10117 Berlin, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Fabienne","family":"Beisegel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3320-0880","authenticated-orcid":false,"given":"Leif-Hendrik","family":"Boldt","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9platz 1, 10117 Berlin, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Abdul Shokor","family":"Parwani","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9platz 1, 10117 Berlin, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Florian","family":"Blaschke","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9platz 1, 10117 Berlin, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0194-4615","authenticated-orcid":false,"given":"Felix","family":"Hohendanner","sequence":"additional","affiliation":[{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9platz 1, 10117 Berlin, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10117 Berlin, Germany"},{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Gerhard","family":"Hindricks","sequence":"additional","affiliation":[{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9platz 1, 10117 Berlin, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10117 Berlin, Germany"},{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Charit\u00e9platz 1, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8818-5964","authenticated-orcid":false,"given":"Kevin","family":"Vernooy","sequence":"additional","affiliation":[{"name":"Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands"},{"name":"Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Dominik","family":"Linz","sequence":"additional","affiliation":[{"name":"Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, 6229 ER Maastricht, The Netherlands"},{"name":"Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), 6229 HX Maastricht, The Netherlands"},{"name":"Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Ingo","family":"Hilgendorf","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9platz 1, 10117 Berlin, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Doreen","family":"Schoeppenthau","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charit\u00e9, Augustenburger Platz 1, 13353 Berlin, Germany"},{"name":"Charit\u00e9-Universit\u00e4tsmedizin Berlin, Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Charit\u00e9platz 1, 10117 Berlin, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10117 Berlin, Germany"},{"name":"Berlin Institute for the Foundations of Learning and Data (BIFOLD), Technical University of Berlin, 10587 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1161\/CIRCRESAHA.119.313572","article-title":"Heart Failure with Preserved Ejection Fraction in Perspective","volume":"124","author":"Pfeffer","year":"2019","journal-title":"Circ. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1038\/nrcardio.2017.65","article-title":"Epidemiology of heart failure with preserved ejection fraction","volume":"14","author":"Dunlay","year":"2017","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"936","DOI":"10.1002\/ejhf.2894","article-title":"Patient Phenotype Profiling in Heart Failure with Preserved Ejection Fraction to Guide Therapeutic Decision Making. A Scientific Statement of the Heart Failure Association, the European Heart Rhythm Association of the European Society of Cardiology, and the European Society of Hypertension","volume":"25","author":"Anker","year":"2023","journal-title":"Eur. J. Heart Fail."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1007\/s10741-025-10504-3","article-title":"Mechanisms of exercise intolerance in heart failure with preserved ejection fraction (HFpEF)","volume":"30","author":"Pecchia","year":"2025","journal-title":"Heart Fail. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"29","DOI":"10.21037\/cdt.2017.06.08","article-title":"Left atrial function: Evaluation by strain analysis","volume":"8","author":"Gan","year":"2018","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"955","DOI":"10.33963\/KP.a2021.0105","article-title":"Left atrial strain\u2014A current clinical perspective","volume":"79","author":"Mandoli","year":"2021","journal-title":"Pol. Heart J. (Kardiol. Pol.)"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1016\/j.hroo.2025.04.007","article-title":"The left atrium in heart failure with preserved ejection fraction: What we know and what we do not know","volume":"6","author":"Haykal","year":"2025","journal-title":"Heart Rhythm O2"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Fauchier, L., Bisson, A., and Bodin, A. (2023). Heart failure with preserved ejection fraction and atrial fibrillation: Recent advances and open questions. BMC Med., 21.","DOI":"10.1186\/s12916-023-02764-3"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2217","DOI":"10.1016\/j.jacc.2016.08.048","article-title":"Heart failure with preserved ejection fraction and atrial fibrillation: Vicious twins","volume":"68","author":"Kotecha","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.hroo.2021.09.015","article-title":"Heart failure with preserved ejection fraction: An alternative paradigm to explain the clinical implications of atrial fibrillation","volume":"2","author":"Ariyaratnam","year":"2021","journal-title":"Heart Rhythm O2"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1093\/ehjci\/jeu165","article-title":"Left atrial dysfunction relates to symptom onset in patients with heart failure and preserved left ventricular ejection fraction","volume":"16","author":"Sanchis","year":"2015","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s12574-025-00695-x","article-title":"Clinical utility of the left atrial strain analysis","volume":"23","author":"Inoue","year":"2025","journal-title":"J. Echocardiogr."},{"key":"ref_14","unstructured":"K\u00f8ber, L., Adamo, M., Ruwald, A.-C., Tomasoni, D., Anderson, L.J., Andersson, C., Brugts, J.J., Chioncel, O., Donal, E., and Ferdinandy, P. (2026). 2026 ESC Guidelines for the management of heart failure: Developed by the task force for the management of heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur. Heart J., ehag100."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Behlouli, H., Feldman, D.E., Ducharme, A., Frenette, M., Giannetti, N., Grondin, F., Michel, C., Sheppard, R., and Pilote, L. (2009). Identifying relative cut-off scores with neural networks for interpretation of the Minnesota Living with Heart Failure questionnaire. 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society, IEEE.","DOI":"10.1109\/IEMBS.2009.5334659"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e010435","DOI":"10.1161\/CIRCEP.121.010435","article-title":"P Wave Parameters and Indices: A Critical Appraisal of Clinical Utility, Challenges, and Future Research\u2014A Consensus Document Endorsed by the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology","volume":"15","author":"Chen","year":"2022","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2018.06.004","article-title":"Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography","volume":"32","author":"Mitchell","year":"2019","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Javadi, N., Bismee, N.N., Abbas, M.T., Scalia, I.G., Pereyra, M., Baba Ali, N., Attaripour Esfahani, S., Awad, K., Farina, J.M., and Ayoub, C. (2024). Left Atrial Strain: State of the Art and Clinical Implications. J. Pers. Med., 14.","DOI":"10.3390\/jpm14111093"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1007\/s00392-024-02562-8","article-title":"Echocardiographic left atrial stiffness index predicts high left ventricular filling pressures in patients with acute heart failure: An observational study","volume":"114","author":"Camilli","year":"2025","journal-title":"Clin. Res. Cardiol."},{"key":"ref_20","unstructured":"Audigier, V. (2026, August 19). clusterMI: Cluster Analysis with Missing Values by Multiple Imputation. Available online: https:\/\/cran.r-project.org\/web\/packages\/clusterMI\/vignettes\/clusterMI.pdf."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1177\/0962280216666564","article-title":"Multiple imputation by chained equations for systematically and sporadically missing multilevel data","volume":"27","author":"White","year":"2018","journal-title":"Stat. Methods Med. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1007\/s11634-022-00519-1","article-title":"Clustering with missing data: Which equivalent for Rubin\u2019s rules?","volume":"17","author":"Audigier","year":"2023","journal-title":"Adv. Data Anal. Classif."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Harada, D., Asanoi, H., Noto, T., and Takagawa, J. (2020). Different Pathophysiology and Outcomes of Heart Failure With Preserved Ejection Fraction Stratified by K-Means Clustering. Front. Cardiovasc. Med., 7.","DOI":"10.3389\/fcvm.2020.607760"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Di Spigno, F., Dall\u2019Ospedale, V., Gerra, L., Breviario, F., Tedeschi, A., Trimarchi, G., and Aschieri, D. (2025). Cardiopulmonary Exercise Testing and HFpEF: Diagnostic and Therapeutic Perspectives. Healthcare, 13.","DOI":"10.3390\/healthcare13233098"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1002\/ehf2.13788","article-title":"Left atrial strain predicts exercise capacity in heart failure independently of left ventricular ejection fraction","volume":"9","author":"Maffeis","year":"2022","journal-title":"ESC Heart Fail."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1161\/CIRCULATIONAHA.114.010637","article-title":"Phenomapping for Novel Classification of Heart Failure With Preserved Ejection Fraction","volume":"131","author":"Shah","year":"2015","journal-title":"Circulation"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1016\/j.jacc.2020.07.009","article-title":"Atrial dysfunction in patients with heart failure with preserved ejection fraction and atrial fibrillation","volume":"76","author":"Reddy","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1093\/ehjci\/jeab222","article-title":"The prognostic impact of mechanical atrial dysfunction and atrial fibrillation in heart failure with preserved ejection fraction","volume":"23","author":"Weerts","year":"2022","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1002\/ejhf.1621","article-title":"Phenomapping of patients with heart failure with preserved ejection fraction using machine learning-based unsupervised cluster analysis","volume":"22","author":"Segar","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1136\/heartjnl-2019-315481","article-title":"Identification of novel pheno-groups in heart failure with preserved ejection fraction using machine learning","volume":"106","author":"Hedman","year":"2020","journal-title":"Heart"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4885","DOI":"10.1038\/s41598-021-84133-9","article-title":"Disproportionate left atrial myopathy in heart failure with preserved ejection fraction among participants of the PROMIS-HFpEF study","volume":"11","author":"Patel","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Monte, I.P., Faro, D.C., Trimarchi, G., de Gaetano, F., Campisi, M., Losi, V., Teresi, L., Di Bella, G., Tamburino, C., and de Gregorio, C. (2023). Left Atrial Strain Imaging by Speckle Tracking Echocardiography: The Supportive Diagnostic Value in Cardiac Amyloidosis and Hypertrophic Cardiomyopathy. J. Cardiovasc. Dev. Dis., 10.","DOI":"10.3390\/jcdd10060261"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1056\/NEJMoa2019422","article-title":"Early Rhythm-Control Therapy in Patients with Atrial Fibrillation","volume":"383","author":"Kirchhof","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1001\/jamacardio.2024.0675","article-title":"Atrial Fibrillation Ablation in Heart Failure with Reduced vs Preserved Ejection Fraction: A Systematic Review and Meta-Analysis","volume":"9","author":"Oraii","year":"2024","journal-title":"JAMA Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Marchandise, S., Garnir, Q., Scav\u00e9e, C., Varnavas, V., le Polain de Waroux, J.B., Wauters, A., Beauloye, C., Roelants, V., and Gerber, B.L. (2022). Prediction of Left Atrial Fibrosis and Success of Catheter Ablation by Speckle Tracking Echocardiography in Patients Imaged in Persistent Atrial Fibrillation. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.856796"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1007\/s12265-017-9759-8","article-title":"Innovative Clinical Trial Designs for Precision Medicine in Heart Failure with Preserved Ejection Fraction","volume":"10","author":"Shah","year":"2017","journal-title":"J. Cardiovasc. Transl. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1038\/s41746-023-00963-z","article-title":"An explainable machine learning-based phenomapping strategy for adaptive predictive enrichment in randomized clinical trials","volume":"6","author":"Oikonomou","year":"2023","journal-title":"npj Digit. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/j.jcmg.2022.11.004","article-title":"Atrial Longitudinal Strain Predicts New-Onset Atrial Fibrillation: A Systematic Review and Meta-Analysis","volume":"16","author":"Serenelli","year":"2023","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.jcmg.2020.07.040","article-title":"Prediction of AF in Heart Failure with Preserved Ejection Fraction: Incremental Value of Left Atrial Strain","volume":"14","author":"Marwick","year":"2021","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Gorter, T.M., van Veldhuisen, D.J., Mulder, B.A., Artola Arita, V.A., van Empel, V.P.M., Manintveld, O.C., Tieleman, R.G., Maass, A.H., Vernooy, K., and van Gelder, I.C. (2023). Prevalence and Incidence of Atrial Fibrillation in Heart Failure with Mildly Reduced or Preserved Ejection Fraction: (Additive) Value of Implantable Loop Recorders. J. Clin. Med., 12.","DOI":"10.3390\/jcm12113682"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1093\/eurheartj\/ehab796","article-title":"Implantable recorders and systematic atrial fibrillation detection do not outperform standard of care in stroke prevention in the LOOP study","volume":"43","author":"Narducci","year":"2022","journal-title":"Eur. Heart J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7538\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:20:32Z","timestamp":1790616032000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7538"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":41,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197538"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197538","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]}}}