急性心肌梗死合并室间隔穿孔患者7 d内死亡风险超声指标预测模型的构建  

Construction of a prediction model of ultrasound indicators for mortality risk within 7 days in patients with acute myocardial infarction and ventricular septal rupture

作　　者：傅云峰[1] 梁中书[2] 冯文畅 Fu Yunfeng;Liang Zhongshu;Feng Wenchang(Department of Blood Transfusion,Xiangya Third Hospital,Central South University,Changsha 410000,Hunan,China;Department of Cardiology,Xiangya Third Hospital,Central South University,Changsha 410000,Hunan,China)

机构地区：[1]中南大学湘雅三医院输血科,湖南长沙410000 [2]中南大学湘雅三医院心内科,湖南长沙410000

出　　处：《中华危重病急救医学》2024年第11期1169-1173,共5页Chinese Critical Care Medicine

基　　金：湖南省自然科学基金(009140819022)。

摘　　要：目的探讨超声心动图指标中影响急性心肌梗死(AMI)合并室间隔穿孔(VSR)患者7 d内死亡的风险因素,并构建超声指标风险列线图模型,预测心肌梗死后室间隔穿孔(PIVSR)患者的死亡风险。方法回顾性分析2014年1月至2024年6月中南大学湘雅三医院心内科收治的40例PIVSR患者的超声心动图数据,根据7 d内存活情况将患者分为死亡组和存活组。采用单因素及多因素分析影响PIVSR患者7 d内死亡的风险因素,并运用R软件构建预测PIVSR患者7 d内死亡的超声指标风险列线图模型。用校准曲线和受试者工作特征曲线(ROC曲线)验证模型的预测效果。结果40例PIVSR患者中7 d内死亡18例,存活22例。单因素分析显示,与存活组比较,死亡组患者年龄较大(岁:73.7±6.8比68.1±7.7),VSR直径较大(mm:10.4±4.2比7.7±3.0),穿孔区分流峰值压差(PPG)更高〔mmHg(1 mmHg≈0.133 kPa):49.0±11.6比37.0±16.1〕,左室射血分数(LVEF)及每搏量(SV)明显降低〔LVEF:0.439±0.134比0.512±0.094,SV(mL):46.1±15.6比62.0±14.3〕,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,年龄〔优势比(OR)=1.212,95%可信区间(95%CI)为1.034~1.420,P=0.018〕、穿孔区PPG(OR=1.248,95%CI为1.069~1.457,P=0.005)是PIVSR患者7 d内死亡的高风险因素,SV是PIVSR患者7 d内死亡的低风险因素(OR=0.851,95%CI为0.756~0.957,P=0.007)。预测PIVSR患者7 d内死亡风险的列线图模型预测值与实际值基本一致,Hosmer-Lemeshow拟合优度检验χ2=10.679,P=0.220。ROC曲线显示,模型预测的曲线下面积(AUC)为0.960,95%CI为0.913~0.998。结论年龄及超声心动图指标SV、穿孔区PPG是PIVSR患者7 d内死亡的风险因素,用上述指标构建的PIVSR患者7 d内死亡风险列线图模型具有较好的区分度和一致性。Objective To investigate the risk factors of death within 7 days in patients with acute myocardial infarction(AMI)complicated by ventricular septal rupture(VSR)based on echocardiography indicators,and to construct a nomogram model of ultrasound indicator risk to predict the risk of death in patients with post-infarction ventricular septal rupture(PIVSR).Methods The echocardiographic data of 40 patients with PIVSR admitted to the department of cardiology,Xiangya Third Hospital,Central South University from January 2014 to June 2024 were retrospectively analyzed.The patients were divided into death group and survival group based on their 7-day survival status.The risk factors affecting death within 7 days of PIVSR patients were analyzed by univariate and multivariate analyses,and the risk nomogram model of ultrasound indicators predicting death within 7 days of PIVSR patients was constructed by using R software.Calibration curve and receiver operator characteristic curve(ROC curve)were used to verify the prediction effect of the model.Results Among the 40 patients with PIVSR,18 died at 7 days and 22 survived.Univariate analysis showed that,compared with the survival group,patients in the death group were older(years old:73.7±6.8 vs.68.1±7.7),had a larger diameter of VSR(mm:10.4±4.2 vs.7.7±3.0),and had a higher peak pressure difference(PPG)in the perforation area[mmHg(1 mmHg≈0.133 kPa):49.0±11.6 vs.37.0±16.1],left ventricular ejection fraction(LVEF)and stroke volume(SV)were significantly decreased[LVEF:0.439±0.134 vs.0.512±0.094,SV(mL):46.1±15.6 vs.62.0±14.3],and the differences were statistically significant(all P<0.05).Multivariate Logistic regression analysis showed that age[odds ratio(OR)=1.212,95%confidence interval(95%CI)was 1.034-1.420,P=0.018]and perforation area PPG(OR=1.248,95%CI was 1.069-1.457,P=0.005)were positively correlated with the occurrence of death events within 7 days in PIVSR patients,while SV was negatively correlated with the occurrence of death events within 7 days in PIVSR patie

关 键 词：急性心肌梗死 室间隔穿孔 超声心动图 预后 列线图模型 

分 类 号：R542.22[医药卫生—心血管疾病]