Precision Subtyping and Prognostic Study of Heart Failure Based on Multi-Omics Integration and Clinical Indicators: A Prospective Single-Center Cohort Study

This prospective single-center cohort study focuses on chronic heart failure (CHF) patients (HFrEF, HFmrEF, HFpEF) and healthy controls, with the core objective of establishing a precision risk stratification model for CHF via multi-omics-clinical integration.

Study Design & Enrollment Participants: 400 CHF patients (meeting 2022 ESC HF guidelines) and 200 age/gender-matched healthy controls (no cardiovascular disease history). Exclusion criteria include acute decompensated HF, end-stage renal disease, active malignancies, and recent antibiotic use (to avoid gut microbiome interference).

Recruitment: Conducted at The First Affiliated Hospital of Xinjiang Medical University over 12 months; eligible participants will provide written informed consent prior to enrollment.

Data & Sample Collection

Baseline:

Clinical data: NYHA functional class, NT-proBNP, echocardiography (LVEF, LVGLS), cardiac CT (EAT density/volume); Multi-omics samples: Plasma (proteome via Olink, metabolome via LC-MS), blood (genome via microarray), feces (gut microbiome via 16S rRNA sequencing; shotgun metagenomics for 200 patients); Follow-up: 3/6/12-month visits to collect clinical outcomes (rehospitalization, mortality), KCCQ quality-of-life scores, and dynamic multi-omics samples (only for SGLT2 inhibitor-treated patients).

Key Analyses Multi-omics characterization: Identify phenotype-specific molecular signatures (e.g., HFpEF-related metabolic profiles) via differential expression and correlation network analysis; Mechanistic exploration: Link gut microbiome composition to circulating metabolites/inflammatory proteins to clarify the "gut-heart axis" in CHF; Model construction: Integrate multi-omics and clinical/imaging indicators to build 4 prediction models (clinical-only, single-omics, multi-omics, integrated), with validation via Harrell's C-statistic and time-dependent ROC.

Quality Control Biological samples: Labeled with unique IDs, stored at -80°C; Imaging data: Independent review by 2 cardiologists (third-party arbitration for discrepancies); Data management: REDCap platform for electronic data capture; independent Data Monitoring Committee (DMC) reviews progress/safety every 6 months.

Inclusion criteria

(1)For chronic heart failure (CHF) patients:1.Meet the 2022 European Society of Cardiology (ESC) diagnostic criteria for CHF, classified into heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with preserved ejection fraction (HFpEF) per ESC guidelines;2.Aged 18 to 80 years (inclusive);3.Able to provide written informed consent independently (or via a legal guardian if cognitively impaired, with a Mini-Mental State Examination [MMSE] score ≥ 24).

(2)For healthy controls:1.No history of cardiovascular disease, confirmed by medical history review and baseline echocardiography;2.Aged 18 to 80 years (inclusive), matched 1:2 with CHF patients by age and gender;3.Able to provide written informed consent.

Exclusion criteria

(1)Acute decompensated heart failure (admitted for acute HF exacerbation within 72 hours prior to enrollment);(2)End-stage renal disease, defined as an estimated glomerular filtration rate (eGFR) < 15 mL/min/1.73m² (confirmed by serum creatinine testing);(3)Active malignancies (receiving systemic treatment within 6 months prior to enrollment) or severe systemic diseases (e.g., severe liver failure, active autoimmune diseases);(4)Antibiotic use within 2 weeks prior to enrollment (may interfere with gut microbiome analysis);(5)Inability to complete 12-month follow-up (e.g., planned long-term overseas residence) or provide required biological samples (e.g., venous blood, fecal samples).