基于临床危险因素和血流动力学的列线图模型用于预测心力衰竭患者MACE的意义  

Predictive significance of nomogrammodel based on clinical risk factors and hemodynamics to major adverse cardiovascular events in patients with heart failure

作　　者：韩溦 郝芳 逯丽丽 杨国红 Han Wei;Hao Fang;Lu Lili;Yang Guohong(Department of Cardiovascular Medicine,Special Medical Center,Chinese People's Armed Police Force,Tianjin 300162,China;不详)

机构地区：[1]中国人民武装警察部队特色医学中心心血管病科,天津300162

出　　处：《中国循证心血管医学杂志》2024年第7期850-855,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的本研究旨在开发一种整合了血流动力学主要参数的综合列线图模型,用于预测心力衰竭(HF)患者主要不良心血管事件(MACE)发病风险。方法对661例接受右心导管插入术(RHC)的症状性心力衰竭患者(年龄64.12±14.14岁;男性占67.47%)进行回顾性研究,并对其进行2年内MACE发生率的主要终点随访。通过最小绝对收缩选择算子(LASSO)回归分析人口统计学信息、实验室测试、经胸超声心动图和RHC血流动力学参数,以选择关键特征。进行多变量逐步Cox分析,以确定独立的风险因素并构建列线图。通过受试者工作特曲线(ROC)、Kaplan-Meier曲线、校准图和决策曲线分析所构建模型的预测值。结果661例心力衰竭患者中,2年MACE发生率为21.48%(n=142)。MACE组年龄偏大,贫血患者比例、左室射血分数降低的HF(HFrEF)患者比例以及入院时收缩压更高;超声心动图参数中,舒张末室间隔厚度(IVST)和左室后壁厚度(LVPWT)更大;实验室指标中,低密度脂蛋白胆固醇和脑钠肽水平偏高,估计肾小球滤过率降低更明显;在RHC血流动力学参数中,右心房压(RAP)、肺动脉收缩压和舒张压、平均肺动脉压、肺动脉楔压和肺血管阻力更高,而心输出量和心脏指数(CI)降低(P<0.05)。经LASSO筛选[ln(λ)=-2.366(λ=0.094)]和多因素Cox回归,确定列线图模型包括6个变量:年龄、贫血、IVST、LVPWT、RAP和CI。ROC曲线显示出对预测模型的良好判别能力(AUC:0.818,95%CI:0.787~0.847)。基于bootstrap方法的模型的列线图校准图显示出良好的性能。预测模型的决策曲线分析显示了列线图模型的净效益优于阈值概率较高的IVST、LVPWT、RAP和CI。根据总列线图得分将患者分为两组:预测概率<0.5为低危组(n=255),预测概率≥0.5为高危组(n=406)。用K-M生存曲线比较不同组间的中位无MACE生存时间,差异有统计学意义(log rank=71.221,P<0.001)。结论本研究开发并验证了心力衰竭患�Objective To develop a comprehensivenomogrammodelintegrated mainhemodynamic parameters for predicting the risks of major adverse cardiovascular events(MACE)in patients with heart failure(HF).Methods HF patients received right heart catheterization(RHC,n=661,aged 64.12±14.14 and 67.47%of male)were retrospectively studied,and followed up for the primary endpoint of MACE incidence within 2 y.The demographic information,laboratory tests,transthoracic echocardiography,and RHC hemodynamic parameters were analyzed for selecting key features by using regression analysis ofleast absolute shrinkage and selection operator(LASSO).The independent risk factors were determined and nomogram was established by using multivariate stepwise Cox analysis.The predictive value of the nomogram model was analyzed by using receiver operating characteristic(ROC)curve,Kaplan-Meier curve,calibration diagram and decision curve.Results Among 661 HF patients,the incidence of MACE was 21.48%(n=142,MACE group)within 2 y.The patients without MACE were included into non-MACE group.In MACE group,the patients were older,and percentages of patients with anemia and heart failure with reduced ejection fraction(HFrEF)and systolic blood pressure(SBP)at admission were higher,indexes of end-diastolic interventricular septal thickness(IVST)and left ventricular posterior wall thickness(LVPWT)were higher,levels of low-density lipoprotein-cholesterol(LDL-C)and brain natriuretic peptide(BNP)were higher,estimated glomerular filtration rate(eGFR)was lower,and right atrial pressure(RAP),systolic pulmonary arterial pressure(sPAP),diastolic pulmonary arterial pressure(dPAP),mean pulmonary arterial pressure(mPAP),pulmonary artery wedge pressure(PAWP)and pulmonary vascular resistance(PVR)were higher,and cardiac output(CO)and cardiac index(CI)were lower(P<0.05).After LASSO screening[ln(λ)=-2.366(λ=0.094)]and multivariate Cox regression analysis,there were 6 variables determined in nomogram model including age,anemia,IVST,LVPWT,RAP and CI.The results of ROC curve anal

关 键 词：心力衰竭 列线图 主要不良心血管事件 右心导管插入术 

分 类 号：R541.61[医药卫生—心血管疾病]