基于左心房僵硬度指数的列线图模型对高龄慢性心力衰竭患者发生心脏不良事件的预测价值

Predictive value on the occurrence of adverse cardiac events in senile patients with chronic heart failure:a nomogram model based on left atrial stiffness index

目的探讨左心房僵硬度指数(LASI)与高龄慢性心力衰竭患者发生心脏不良事件的相关性,并基于LASI建立列线图预测模型。方法回顾性分析181例高龄慢性心力衰竭患者的临床资料,根据随访2年期间有无发生心脏不良事件将患者分为观察组(发生心脏不良事件,72例)和对照组(未发生心脏不良事件,109例)。比较两组患者的临床资料、实验室检查结果和心脏多普勒超声检查结果。采用多因素Logistic回归模型分析患者发生心脏不良事件的影响因素,并构建列线图预测模型。结果观察组纽约心脏协会分级≥Ⅲ级比例、LASI、二尖瓣瓣口舒张早期峰值血流速度/二尖瓣瓣环舒张早期速度(E/e′)及血清B型钠尿肽(BNP)、肌酐、尿酸水平高于对照组,左心室射血分数(LVEF)低于对照组(均P<0.05)。纽约心脏协会分级、血清BNP水平、LASI、E/e′、血清肌酐水平为高龄慢性心力衰竭患者发生心脏不良事件的危险因素,LVEF为保护因素(均P<0.05)。列线图预测模型预测高龄慢性心力衰竭患者发生心脏不良事件的一致性指数为0.911,预测准确率为96.52%,灵敏度为97.22%,特异度为96.12%,阳性预测值为93.33%,阴性预测值为98.41%,受试者工作特征曲线下面积达0.953。结论LASI是高龄慢性心力衰竭患者发生心脏不良事件的影响因子,基于LASI建立的列线图预测模型可为评估患者预后提供重要依据。

Objective To explore the correlation of left atrial stiffness index(LASI)with the occurrence of adverse cardiac events in senile patients with chronic heart failure,and to construct the nomogram predictive model based on LASI.Methods The clinical data of 181 senile patients with chronic heart failure were retrospectively analyzed,and they were assigned to observation group(suffering from adverse cardiac events,72 cases)or control group(without adverse cardiac events,109 cases)according to whether the occurrence of adverse cardiac events presented during 2-year follow-up period.The clinical data,laboratory examination results,and cardiac Doppler ultrasound examination results were compared between the two groups.The influencing factors for the occurrence of adverse cardiac events in patients were analyzed by the multivariate Logistic regression model,and the nomogram predictive model was constructed.Results The observation group exhibited higher proportion of New York Heart Association classification≥Ⅲ,LASI,early diastolic peak blood flow velocity of mitral valve orifice/early diastolic velocity of mitral valve ring(E/e′),and higher serum B-type natriuretic peptide(BNP),creatinine,uric acid levels,whereas a lower left ventricular ejection fraction(LVEF)as compared with the control group(all P<0.05).New York Heart Association classification,serum BNP level,LASI,E/e′,and serum creatinine level were the risk factors for the occurrence of adverse cardiac events in senile patients with chronic heart failure,and LVEF was the protective factor(all P<0.05).For predicting the occurrence of adverse cardiac events in senile patients with chronic heart failure,the consistency index of the nomogram was 0.911,the predictive accuracy was 96.52%,the sensitivity was 97.22%,the specificity was 96.12%,the positive predictive value was 93.33%,and the negative predictive value was 98.41%,as well as the area under the receiver operating characteristic curve reached 0.953.Conclusion LASI is an influencing factor for the occurrence of adverse cardiac events in senile patients with chronic heart failure,and the nomogram predictive model constructed based on LASI can provide a crucial basis for evaluating the prognosis of patients.