心脏瓣膜置换术后并发严重室性心律失常危险因素的探讨及风险列线图模型的建立

Risk factors of severe ventricular arrhythmia after heart valve replacement and establishment of its risk nomogram model

目的:探究心脏瓣膜置换术后并发严重室性心律失常的独立危险因素,同时建立预测心脏瓣膜置换术后发生严重室性心律失常风险的列线图模型。方法:回顾性分析2016年12月-2018年12月在华西医院心脏大血管外科行心脏瓣膜置换术患者275例,通过单因素及多因素Logistic回归分析得到心脏瓣膜置换术后并发严重室性心律失常的独立危险因素,最终应用R语言建立预测术后发生严重室性心律失常风险的列线图模型并对该模型进行验证。结果:由多因素Logistic回归分析结果可知,病程(OR=3.040,95%CI:1.249~7.403)、左室射血分数(LVEF)(OR=2.953,95%CI:1.135~3.363)、重度三尖瓣关闭不全(OR=2.171,95%CI:1.194~3.946)、主动脉断流时间(OR=2.494,95%CI:1.025~2.923)、体外循环时间(OR=1.754,95%CI:1.010~3.046)以及术后血流动力学紊乱(OR=2.488,95%CI:1.230~5.031)为心脏瓣膜置换术后并发严重室性心律失常的独立危险因素;基于上述危险因素成功建立列线图模型。验证后发现预测值同实测值基本一致,提示预测模型预测能力良好;随后采用Bootstrap内部验证法对预测模型进行验证,C-index为0.781(95%CI:0.725~0.836),说明该列线图预测模型预测效能高。结论:病程≥10年、LVEF<40%、重度三尖瓣关闭不全、主动脉断流时间>90 min、体外循环时间>120 min以及术后血流动力学紊乱是心脏瓣膜置换术后并发严重室性心律失常的独立危险因素,基于上述危险因素建立的列线图模型具有良好预测效能,有重要临床价值。

Objective:To investigate the independent risk factors of severe ventricular arrhythmia after heart valve replacement and to establish a nomogram model for predicting the risk of severe ventricular arrhythmia after heart valve replacement.Method:A retrospective analysis of 275 patients undergoing cardiac valve replacement in the Department of Cardiac Vascular Surgery from Huaxi Hospital from December 2016 to December 2018 was enrolled.Univariate and multivariate logistic regression analysis was performed to obtain independent risk factors of severe ventricular arrhythmia after cardiac valve replacement.Independent risk factors were used to establish a nomogram model for predicting the risk of severe ventricular arrhythmia after surgery and to validate the model.Result:The results of multivariate logistic regression analysis showed that the disease duration(OR=3.040,95%CI:1.249-7.403),LVEF(OR=2.953,95%CI:1.135-3.363),severe tricuspid insufficiency(OR=2.171,95%CI:1.194-3.946),aortic crossclamp time(OR=2.494,95%CI:1.025-2.923),cardiopulmonary bypass time(OR=1.754,95%CI:1.010-3.046)and hemodynamic disorder(OR=2.488,95%CI:1.230-5.031)were independent risk factors for severe ventricular arrhythmia after heart valve replacement.The nomogram model was successfully established based on the above risk factors.It was consistent with the measured values,which indicates that the prediction model had good prediction ability.Then the Bootstrap internal verification method was used to verify the prediction model.The C-index is 0.781(95%CI:0.725-0.836),which indicating that the nomogram model performed well.Conclusion:The disease duration≥10 years,LVEF<40%,severe tricuspid insufficiency,aortic crossclamp time over 90 minutes,cardiopulmonary bypass time over 120 minutes,and hemodynamic disorder are independent risk factors of serious ventricular arrhythmia after cardiac valve replacement.Nomogram model based on these risk factors has good predictive efficacy and important clinical value.