主动脉瓣狭窄病变患者TAVI术后发生瓣周漏的预测模型构建及验证  

Construction and validation of a prediction model of perivalvular leakage in patients with aortic stenosis after TAVI operation

作　　者：沈剑虹[1] 杨向东 牛伟[1] 双链 SHEN Jianhong;YANG Xiangdong;NIU Wei;SHUANG Lian(Department of Cardiovascular Medicine,The First Hospital of Hohhot,Hohhot 010030,China;Department of Geriatrics,Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010030,China)

机构地区：[1]内蒙古呼和浩特市第一医院心血管内科,内蒙古自治区呼和浩特010030 [2]内蒙古医科大学附属医院老年医学科,内蒙古自治区呼和浩特010030

出　　处：《兰州大学学报(医学版)》2025年第2期17-24,共8页Journal of Lanzhou University(Medical Sciences)

基　　金：内蒙古医科大学面上科研项目(YKD2022MS077)。

摘　　要：目的分析主动脉瓣狭窄病变患者经皮主动脉瓣置换术(TAVI)术后发生中度及以上瓣周漏的危险因素并构建预测模型,同时对模型进行验证。方法回顾性收集128例行TAVI治疗的主动脉瓣狭窄病变患者临床资料,所有受试者根据术后是否发生中度及以上瓣周漏分为发生组和未发生组,收集两组患者临床资料。采用单因素和多因素分析影响主动脉瓣狭窄病变患者TAVI术后发生瓣周漏的危险因素。将筛选出的危险因素纳入多因素Logistic回归,利用R软件绘制列线图模型,并对模型进行验证。结果TAVI术后,128例患者中,13例患者发生中度瓣周漏,7例患者发生重度瓣周漏。中度及以上瓣周漏发生风险为15.63%。发生组男性占比、左心室舒张末期内径、左心室收缩末期内径、瓣环直径、瓣环钙化体积、主动脉成角、左心室流出道(LVOT)覆盖指数、瓣膜植入深度水平均高于未发生组(P>0.05),发生组相对室壁厚度(RWT)低于未发生组(P<0.05)。Logistic回归分析结果显示RWT<0.48、瓣环钙化体积≥596.45 mm^(3)、主动脉成角≥54.23°、LVOT覆盖指数≥0.89、瓣膜植入深度≥10.12 mm均是影响主动脉瓣狭窄患者术后发生中度及以上瓣周漏的危险因素(P<0.05)。受试者操作特征(ROC)曲线结果显示,列线图模型预测主动脉瓣狭窄病变患者TAVI术后发生中度及以上瓣周漏的曲线下面积为0.871(95%CI:[0.657,0.996]),灵敏度、特异度分别为95.30%、79.40%,表明该模型预测效能良好。列线图预测模型C指数为0.836(95%CI:[0.785,0.945])。校准曲线结果显示,Apparent校正曲线与Bias-corrected校正曲线均在理想曲线附近,且Hosmer-Lemeshow拟合优度曲线检验χ^(2)=2.987,P=0.637。决策曲线显示,当阈值概率为[0,0.7]时,净收益>0,具有较好的临床实用性。净收益随着阈值的降低而增加,净收益的最大值为0.184。结论本研究构建的风险列线图模型对主动脉瓣狭窄患�Objective To analyze risk factors of moderate or more perivalvular leakage after percutaneous aortic valve replacement(TAVI)in patients with aortic stenosis,and construct the risk prediction model of moderate or more perivalvular leakage,and validate the constructed model.Methods Clinical data of 128 patients with aortic stenosis undergoing TAVI treatment were retrospectively collected.All subjects were divided into occurrence group and non-occurrence group according to whether moderate or above perivalvular leakage occurred after surgery.Clinical data of the two groups were collected.The risk factors of perivalvular leakage after TAVI in patients with aortic stenosis were analyzed by univariate and multivariate analysis.The selected risk factors were incorporated into R software to construct the risk diagram model of perivalvular leakage in patients with arterial stenosis after TAVI surgery,and the constructed model was verified.Results Of the 128 patients,13 had moderate perivalvular leakage and 7 had severe perivalvular leakage after TAVI.The risk of moderate or above perivalvular leakage was 15.63%.The male proportion of left ventricular end-diastolic diameter,left ventricular end-systolic diameter,valve ring diameter,valve ring calcification volume,aortic angulation,left ventricular outflow tract(LVOT)coverage index and valve implantation depth in the occurrence group were higher than those in the non-occurrence group(P>0.05),and the relative wall thickness(RWT)in the occurrence group was lower than that in the non-occurrence group(P<0.05).Logistic regression analysis showed that RWT(<0.48),annular calcification volume(≥596.45 mm^(3)),aortic angulation(≥54.23°),LVOT coverage index(≥0.89),and valve implantation depth(≥10.12 mm)were risk factors for moderate or higher perivalvular leakage in patients with aortic stenosis(P<0.05).Receiver operating characteristics(ROC)curve results showed that the area under the curve of the nomogram risk model predicting moderate or more perivalvular leakage in patien

关 键 词：主动脉瓣狭窄病变 经皮主动脉瓣置换术 瓣周漏 列线图模型 预测模型 危险因素 

分 类 号：R541[医药卫生—心血管疾病]